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Sample records for care sensitive conditions

  1. [Hospital Costs of Ambulatory Care-Sensitive Conditions in Germany].

    Science.gov (United States)

    Fischbach, D

    2016-03-01

    Ambulatory care-sensitive conditions (ACSC) are defined as conditions that lead to a hospital admission of which the onset could have been prevented through a more easily accessible ambulatory sector or one that provides better quality care. They are used by health-care systems as a quality indicator for the ambulatory sector. The definition for ACSC varies internationally. Sets of conditions have been defined and evaluated already in various countries, e. g., USA, England, New Zealand and Canada, but not yet for Germany. Therefore this study aims to evaluate the hospital costs of ACSC in Germany using the National Health Service's set of ACSC. In order to calculate these costs a model has been set up for the time period between 2003 and 2010. It is based on G-DRG browsers issued by the German Institute for the Hospital Remuneration System as required by German law. Within these browsers all relevant DRG-ICD combinations have been extracted. The number of cases per combination was then multiplied by their corresponding cost weights and the average effective base rates. The results were then aggregated into their corresponding ICD groups and then into their respective conditions which lead to the costs per condition and the total costs. The total number of cases and total costs were then compared to another second source. These calculations resulted in 11.7 million cases, of which 10.7% were defined as ambulatory care-sensitive. Within the analysed time period the number of ambulatory care-sensitive cases increased by 6% in total and had a 0.9% CAGR. The corresponding costs amounted to a total of EUR 37.6B and to EUR 3.3B for ACSC. 60% of the costs were caused by three of the 19 ACSC. These results validate that it is worthwhile to further investigate this quality indicator for the ambulatory sector. PMID:25918929

  2. Hospitalization for ambulatory care sensitive conditions and the role of primary care in Italian regions.

    Directory of Open Access Journals (Sweden)

    Aldo Rosano

    2011-03-01

    Full Text Available Abstract
    Background: Hospitalization may often be prevented by timely and effective outpatient care either by preventing the onset of an illness, controlling an acute illness or managing a chronic disease with an appropriate follow-up. The objective of the study is to examine the variability of hospital admissions within Italian regions for Ambulatory Care Sensitive Conditions (ACSCs, and their relationship with primary care supply.
    Methods: Hospital discharge data aggregated at a regional level collected in 2005 were analysed by type of ACS conditions. Main outcome measures were regional hospital admission rates for ACSCs. Negative binomial models were used to analyse the association with individual risk factors (age and gender and regional risk factors (propensity to hospitalisation and prevalence of specific conditions.
    Non-parametric correlation indexes between standardised hospital admission rates and quantitative measures of primary care services were calculated.
    Results: ACSC admissions accounted for 6.6% of total admissions, 35.7% were classified as acute conditions and 64.3% as chronic conditions. Admission rates for ACSCs varied widely across Italian regions with different patterns for chronic and acute conditions. Southern regions showed significantly higher rates for chronic conditions and North-eastern regions for acute conditions. We found a significant negative association between the provision of ambulatory specialist services and standardised hospitalization rates
    (SHR for ACS chronic conditions (r=-0.50; p=0.02 and an inverse correlation among SHR for ACS acute conditions and the rate of GPs per 1,000 residents, although the latter was not statistically significant.
    Conclusions: In Italy, about 480,000 inpatient hospital admissions in 2005 were attributable to ACSCs. Even
    adjusting for potential confounders

  3. Strategies for reducing potentially avoidable hospitalizations for ambulatory care-sensitive conditions

    NARCIS (Netherlands)

    Freund, T.; Campbell, S.M.; Geissler, S.; Kunz, C.U.; Mahler, C.; Peters-Klimm, F.; Szecsenyi, J.

    2013-01-01

    PURPOSE: Hospitalizations for ambulatory care-sensitive conditions (ACSCs) are seen as potentially avoidable with optimal primary care. Little is known, however, about how primary care physicians rate these hospitalizations and whether and how they could be avoided. This study explores the complex c

  4. Ambulatory Care Sensitive Conditions in Persons with an Intellectual Disability--Development of a Consensus

    Science.gov (United States)

    Balogh, Robert S.; Ouellette-Kuntz, Helene; Brownell, Marni; Colantonio, Angela

    2011-01-01

    Background: There is evidence that the primary care provided for persons with an intellectual disability living in the community has been inadequate. Hospitalization rates for ambulatory care sensitive (ACS) conditions are considered an indicator for access to, and quality of, primary care. The objective of this research was to identify ACS…

  5. AMBULATORY CARE - SENSITIVE CONDITIONS IN CHILDREN UNDER FIVE YEARS

    Directory of Open Access Journals (Sweden)

    Maria Aparecida Araújo Figueiredo

    2013-05-01

    Full Text Available Objective:analyzethe extent to which the incidence rate of primary care sensitivehospitalizations in children under five years is influenced by the percentage of coverage of theprimary care.Methods:This was a cross-sectional ecological study that combines coverage ofprimary careand theambulatorycare-sensitiveconditionsin 2000 and 2010. We used data from theHospital Information System (HIS and the Information System of Primary Care (SIAB.Results:The data revealed that the increased coverage providedprimary carereductionrateofhospitalization diseases studied. In 2000 the reduction was greater for gastroenteritis (51% inchildren under 01 years and 30% in children 01-04 years in 2010 for respiratory diseases (51% inchildren under 01years and 33% in children aged 01-04 years.Conclusion:we found an association between the coverage ofprimary careand admission rates, however seem to affect othervariables, suggesting the need for further studies.

  6. Record of hospitalizations for ambulatory care sensitive conditions: validation of the hospital information system

    Directory of Open Access Journals (Sweden)

    Tania Cristina Morais Santa Barbara Rehem

    2013-09-01

    Full Text Available OBJECTIVE: to estimate the sensitivity, specificity and positive and negative predictive values of the Unified Health System's Hospital Information System for the appropriate recording of hospitalizations for ambulatory care-sensitive conditions. METHOD: the hospital information system records for conditions which are sensitive to ambulatory care, and for those which are not, were considered for analysis, taking the medical records as the gold standard. Through simple random sampling, a sample of 816 medical records was defined and selected by means of a list of random numbers using the Statistical Package for Social Sciences. RESULT: the sensitivity was 81.89%, specificity was 95.19%, the positive predictive value was 77.61% and the negative predictive value was 96.27%. In the study setting, the Hospital Information System (SIH was more specific than sensitive, with nearly 20% of care sensitive conditions not detected. CONCLUSION: there are no validation studies in Brazil of the Hospital Information System records for the hospitalizations which are sensitive to primary health care. These results are relevant when one considers that this system is one of the bases for assessment of the effectiveness of primary health care.

  7. Perceived Stress, Multimorbidity, and Risk for Hospitalizations for Ambulatory Care-sensitive Conditions

    DEFF Research Database (Denmark)

    Prior, Anders; Vestergaard, Mogens; Davydow, Dimitry S;

    2016-01-01

    BACKGROUND: Psychiatric disorders are associated with an increased risk for ambulatory care-sensitive condition (ACSC)-related hospitalizations, but it remains unknown whether this holds for individuals with nonsyndromic stress that is more prevalent in the general population. OBJECTIVES.......67) after fully adjusting for multimorbidity and socioeconomic factors. Individuals with above reference stress levels experienced 1703 excess ACSC-related hospitalizations (18% of all). A dose-response relationship was observed between perceived stress and the ACSC-related hospitalization rate regardless...

  8. The Role of Rural Health Clinics in Hospitalization Due to Ambulatory Care Sensitive Conditions: A Study in Nebraska

    Science.gov (United States)

    Zhang, Wanqing; Mueller, Keith J.; Chen, Li-Wu; Conway, Kevin

    2006-01-01

    Context: Hospitalization due to ambulatory care sensitive conditions (ACSCs) is often used as an indicator for measuring access to primary care. Rural health clinics (RHCs) provide basic primary care services for rural residents in health professional shortage areas (HPSAs). The relationship between RHCs and ACSCs is unclear. Purpose: The purpose…

  9. Hospitalisation Rates for Ambulatory Care Sensitive Conditions for Persons with and without an Intellectual Disability--A Population Perspective

    Science.gov (United States)

    Balogh, R.; Brownell, M.; Ouellette-Kuntz, H.; Colantonio, A.

    2010-01-01

    Background: There is evidence that persons with an intellectual disability (ID) face barriers to primary care; however, this has not been extensively studied at the population level. Rates of hospitalisation for ambulatory care sensitive conditions are used as an indicator of access to, and quality of, primary care. The objective of the study was…

  10. Overview of hospitalizations by ambulatory care sensitive conditions in the municipality of Cotia, Brazil

    Directory of Open Access Journals (Sweden)

    Renata Laszlo Torres

    2014-08-01

    Full Text Available Objective To describe the profile of Hospitalizations by Amulatory Care Sensitive Conditions (HACSC, in the Municipality of Cotia, from 2008 to 2012. Method ecological, exploratory, longitudinal study with a quantitative approach. Data on HACSC, by age group and sex, were obtained from the Department of the Unified Health System. For data analysis descriptive statistics were used. Results During the period, there were 46,676 admissions, excluding deliveries, 7,753 (16.61% by HACSC. The main causes were cerebrovascular diseases, 16.96%, heart failure, 15.50%, hypertension, 10.80% and infection of the kidney and urinary tract, 10.51%. Regarding gender, HACSC occurred predominantly in males. There was a greater number of HACSC at extreme age ranges, especially in the elderly. Conclusion Chronic diseases predominate among the leading causes of HACSC and there was no significant difference between sex.

  11. Hospitalisations and costs relating to ambulatory care sensitive conditions in Ireland.

    LENUS (Irish Health Repository)

    Sheridan, A

    2012-03-08

    BACKGROUND: Ambulatory care sensitive conditions (ACSCs) are conditions for which the provision of timely and effective outpatient care can reduce the risks of hospitalisation by preventing, controlling or managing a chronic disease or condition. AIMS: The aims of this study were to report on ACSCs in Ireland, and to provide a baseline for future reference. METHODS: Using HIPE, via Health Atlas Ireland, inpatient discharges classified as ACSCs using definitions from the Victorian ACSC study were extracted for the years 2005-2008. Direct methods of standardisation allowed comparison of rates using the EU standard population as a comparison for national data, and national population as comparison for county data. Costs were estimated using diagnosis-related groups. RESULTS: The directly age-standardised discharge rate for ACSC-related discharges increased slightly, but non-significantly, from 15.40 per 1,000 population in 2005 to 15.75 per 1,000 population in 2008. The number of discharges increased (9.5%) from 63,619 in 2005 to 69,664 in 2008, with the estimated associated hospital costs increasing (31.5%) from 267.8 million in 2005 to 352.2 million in 2008. Across the country, there was considerable variation in the discharge rates for the Top-10 ACSCs for the years 2005-2008. Significantly lower rates of hospitalisation were observed in more urban areas including Cork, Dublin and Galway. The most common ACSC in 2008 was diabetes with complications (29.8%). CONCLUSIONS: The variation in rates observed indicates the scope of reducing hospitalisations and associated costs for ACSCs, across both adult\\'s and children\\'s services and particularly in relation to diabetes complications.

  12. Factors Associated with Hospitalisations for Ambulatory Care-Sensitive Conditions among Persons with an Intellectual Disability--A Publicly Insured Population Perspective

    Science.gov (United States)

    Balogh, R. S.; Ouellette-Kuntz, H.; Brownell, M.; Colantonio, A.

    2013-01-01

    Background: Hospitalisations for ambulatory care-sensitive (ACS) conditions are used as an indicator of access to, and the quality of, primary care. The objective was to identify factors associated with hospitalisations for ACS conditions among adults with an intellectual disability (ID) in the context of a publicly insured healthcare system.…

  13. Income level and chronic ambulatory care sensitive conditions in adults: a multicity population-based study in Italy

    Directory of Open Access Journals (Sweden)

    Forastiere Francesco

    2009-12-01

    Full Text Available Abstract Background A relationship between quality of primary health care and preventable hospitalizations has been described in the US, especially among the elderly. In Europe, there has been a recent increase in the evaluation of Ambulatory Care Sensitive Conditions (ACSC as an indicator of health care quality, but evidence is still limited. The aim of this study was to determine whether income level is associated with higher hospitalization rates for ACSC in adults in a country with universal health care coverage. Methods From the hospital registries in four Italian cities (Turin, Milan, Bologna, Rome, we identified 9384 hospital admissions for six chronic conditions (diabetes, hypertension, congestive heart failure, angina pectoris, chronic obstructive pulmonary disease, and asthma among 20-64 year-olds in 2000. Case definition was based on the ICD-9-CM coding algorithm suggested by the Agency for Health Research and Quality - Prevention Quality Indicators. An area-based (census block income index was used for each individual. All hospitalization rates were directly standardised for gender and age using the Italian population. Poisson regression analysis was performed to assess the relationship between income level (quintiles and hospitalization rates (RR, 95% CI separately for the selected conditions controlling for age, gender and city of residence. Results Overall, the ACSC age-standardized rate was 26.1 per 10.000 inhabitants. All conditions showed a statistically significant socioeconomic gradient, with low income people being more likely to be hospitalized than their well off counterparts. The association was particularly strong for chronic obstructive pulmonary disease (level V low income vs. level I high income RR = 4.23 95%CI 3.37-5.31 and for congestive heart failure (RR = 3.78, 95% CI = 3.09-4.62. With the exception of asthma, males were more vulnerable to ACSC hospitalizations than females. The risks were higher among 45-64 year

  14. [Hospitalizations for ambulatory care-sensitive conditions: validation study at a Hospital Information System (SIH) in the Federal District, Brazil, in 2012].

    Science.gov (United States)

    Cavalcante, Danyelle Monteiro; Oliveira, Maria Regina Fernandes de; Rehem, Tânia Cristina Morais Santa Bárbara

    2016-01-01

    This study analyzes hospitalizations due to ambulatory care-sensitive conditions with a focus on infectious and parasitic diseases (IPDs) and validates the Hospital Information System, Brazilian Unified National Health System (SIH/SUS) for recording hospitalizations due to ambulatory care-sensitive conditions in a hospital in the Federal District, Brazil, in 2012. The study estimates the sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of the SIH for recording hospitalizations due to ambulatory care-sensitive conditions, with the patient's medical file as the gold standard. There were 1,604 hospitalizations for hospitalizations due to ambulatory care-sensitive conditions (19.6%, 95%CI: 18.7-20.5), and the leading IPDs were renal and urinary tract infection, infection of the skin and subcutaneous tissue, and infectious gastroenteritis. IPDs were the leading cause of hospitalization in the 20 to 29-year age bracket and caused 28 deaths. Sensitivity was 70.1% (95%CI: 60.5-79.7), specificity 88.4% (95%CI: 85.6-91.2), PPV = 51.7% (95%CI: 42.7-60.7), and NPV = 94.3% (95%CI: 92.2-96.4). The findings for admissions due to ACSCs in this hospital were similar to those of other studies, featuring admissions for IPDs. The SIH/SUS database was more specific than sensitive. PMID:27027457

  15. Association between community health center and rural health clinic presence and county-level hospitalization rates for ambulatory care sensitive conditions: an analysis across eight US states

    Directory of Open Access Journals (Sweden)

    Laditka Sarah B

    2009-07-01

    Full Text Available Abstract Background Federally qualified community health centers (CHCs and rural health clinics (RHCs are intended to provide access to care for vulnerable populations. While some research has explored the effects of CHCs on population health, little information exists regarding RHC effects. We sought to clarify the contribution that CHCs and RHCs may make to the accessibility of primary health care, as measured by county-level rates of hospitalization for ambulatory care sensitive (ACS conditions. Methods We conducted an ecologic analysis of the relationship between facility presence and county-level hospitalization rates, using 2002 discharge data from eight states within the US (579 counties. Counties were categorized by facility availability: CHC(s only, RHC(s only, both (CHC and RHC, and neither. US Agency for Healthcare Research and Quality definitions were used to identify ACS diagnoses. Discharge rates were based on the individual's county of residence and were obtained by dividing ACS hospitalizations by the relevant county population. We calculated ACS rates separately for children, working age adults, and older individuals, and for uninsured children and working age adults. To ensure stable rates, we excluded counties having fewer than 1,000 residents in the child or working age adult categories, or 500 residents among those 65 and older. Multivariate Poisson analysis was used to calculate adjusted rate ratios. Results Among working age adults, rate ratio (RR comparing ACS hospitalization rates for CHC-only counties to those of counties with neither facility was 0.86 (95% Confidence Interval, CI, 0.78–0.95. Among older adults, the rate ratio for CHC-only counties compared to counties with neither facility was 0.84 (CI 0.81–0.87; for counties with both CHC and RHC present, the RR was 0.88 (CI 0.84–0.92. No CHC/RHC effects were found for children. No effects were found on estimated hospitalization rates among uninsured populations

  16. Pavlovian conditioning and multiple chemical sensitivity.

    OpenAIRE

    Siegel, S.; Kreutzer, R

    1997-01-01

    Pavlovian conditioning processes may contribute to some symptoms of multiple chemical sensitivity (MCS). This review summarizes the potential relevance of the literature on conditional taste and olfactory aversions, conditional sensitization, and conditional immunomodulation to understanding MCS. A conditioning-based perspective on MCS suggests novel research and treatment strategies.

  17. Habituation, sensitization, and Pavlovian conditioning

    OpenAIRE

    Münire Özlem Çevik

    2014-01-01

    In this brief review, I argue that the impact of a stimulus on behavioral control increase as the distance of the stimulus to the body decreases. Habituation, i.e., decrement in response intensity repetition of the triggering stimulus, is the default state for sensory processing, and the likelihood of habituation is higher for distal stimuli. Sensitization, i.e., increment in response intensity upon stimulus repetition, occurs in a state dependent manner for proximal stimuli that make direct ...

  18. CONDITIONS LIFE OF SENIORS IN RESIDENTIAL CARE

    Directory of Open Access Journals (Sweden)

    Wildmannová Mirka

    2014-05-01

    Full Text Available Residential care for seniors belongs to current trends in now days debate on the quality of life for retirement people. Common problem to all EU Member States is the problem of aging population. European governments are currently addressed to the issue of the quality of life of seniors. Particularly provision of contingencies for outreach, non-resident and residential services – its setting, structure, financing and quality. The target group are seniors, men and women, who live in and use services of facilities residential care. A questionnaire survey was conducted in nine homes for the elderly in the South Moravian Region and 23 questions were included. The 252 respondents participated with the questionnaires. This paper aim is to evaluate the research which was carried out in residential care facilities for elderly. The research question was mainly quality care provided for the elderly and the reason for making the decision about entering this type of sanitary facilities/care-taking institution. All age groups are represented in residential care facilities, half of them receiving the care allowance. All respondents qualified the quality of service as good, and they were satisfied with a range of leisure activities. The research showed that residential care is not a threat to the quality of life of elderly people, but is offering them the conditions for fully spent time with no loss of their dignity. I infer a recommendation that any financial support to municipalities and counties for the establishment of residential housing for seniors is based on the research carried out and it is as well the right recommendations for future conception of housing in old age.

  19. Unmet health care needs for persons with environmental sensitivity

    OpenAIRE

    Gibson PR; Kovach S; Lupfer A

    2015-01-01

    Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions ...

  20. Unmet health care needs for persons with environmental sensitivity

    Directory of Open Access Journals (Sweden)

    Gibson PR

    2015-01-01

    Full Text Available Pamela Reed Gibson, Shannon Kovach, Alexis LupferDepartment of Psychology, James Madison University, Harrisonburg, VA, USAAbstract: Studies of unmet health care needs have shown that women, people with poor health, and people with lower socioeconomic status are more likely to report having unmet health care needs. In this study, we examined the types of and reasons for unmet health care needs in 465 people with environmental sensitivities. A second area of inquiry involved negative reactions to general anesthesia. Results showed that the most common barriers to receiving care were the inability to find a provider who understands environmental sensitivities and a lack of accessibility due to chemical and electromagnetic exposures in health care environments. Lower income and poorer health (longer illness, a worsening or fluctuating course of illness, and a higher level of disability were significantly correlated with the total number of reported unmet health care needs. Some people with environmental sensitivities reported having negative reactions to anesthesia of long duration; most common were nausea and vomiting, fatigue, and reduced cognitive ability.Keywords: environmental sensitivity, chemical sensitivity, electrohypersensitivity, chemical hypersensitivity, chemical intolerance, contested illness

  1. 42 CFR 494.100 - Condition: Care at home.

    Science.gov (United States)

    2010-10-01

    ...) Proper waste storage and disposal procedures. (b) Standard: Home dialysis monitoring. The dialysis... 42 Public Health 5 2010-10-01 2010-10-01 false Condition: Care at home. 494.100 Section 494.100... Patient Care § 494.100 Condition: Care at home. A dialysis facility that is certified to provide...

  2. Condition based payment: improving care of chronic illness

    OpenAIRE

    DiPiero, Albert; Sanders, David G

    2005-01-01

    Fee-for-service is more than a payment method; it defines the method of care. Fee-for-condition—a payment method that rewards superior results and encourages innovation—could greatly improve care for chronic conditions

  3. Primary care patient willingness for genetic testing for salt-sensitive hypertension: a cross sectional study

    OpenAIRE

    Okayama, Masanobu; Takeshima, Taro; Ae, Ryusuke; Harada, Masanori; Kajii, Eiji

    2013-01-01

    Background The current research into single nucleotide polymorphisms has extended the role of genetic testing to the identification of increased risk for common medical conditions. Advances in genetic research may soon necessitate preparation for the role of genetic testing in primary care medicine. This study attempts to determine what proportion of patients would be willing to undergo genetic testing for salt-sensitive hypertension in a primary care setting, and what factors are related to ...

  4. Care plans and care planning in long term conditions: a conceptual model

    OpenAIRE

    Burt, J.; J. Rick; Blakeman, T; Protheroe, J; Roland, M; Bower, P.

    2013-01-01

    The prevalence and impact of long term conditions continues to rise. Care planning for people with long term conditions has been a policy priority for chronic disease management in a number of health care systems. However, patients and providers appear unclear about the formulation and implementation of care planning. Further work in this area is therefore required to inform the development, implementation and evaluation of future care planning initiatives. We distinguish between ‘care planni...

  5. Care of Adult Refugees with Chronic Conditions.

    Science.gov (United States)

    Terasaki, Genji; Ahrenholz, Nicole Chow; Haider, Mahri Z

    2015-09-01

    Refugees share a common experience of displacement from their country of origin, migration, and resettlement in an unfamiliar country. More than 17 million people have fled their home countries due to war, generalized violence, and persecution. US primary care physicians must care for their immediate and long-term medical needs. Challenges include (1) language and cultural barriers, (2) high rates of mental health disorders, (3) higher prevalence of latent infections, and (4) different explanatory models for chronic diseases. This article discusses management strategies for common challenges that arise in the primary care of refugees. PMID:26320045

  6. Patients’ perceptions of actual care conditions and patient satisfaction with care quality in hospital

    OpenAIRE

    Abrahamsen Grøndahl, Vigdis

    2012-01-01

    There are theoretical and methodological difficulties in measuring the concepts of quality of care and patient satisfaction, and the conditions associated with these concepts. A theoretical framework of patient satisfaction and a theoretical model of quality of care have been used as the theoretical basis in this thesis. Aim. The overall aim was to describe and explore relationships between person-related conditions, external objective care conditions, patients’ perceptions of quality of care...

  7. Primary Care of Adult Women: Common Dermatologic Conditions.

    Science.gov (United States)

    Ruiz de Luzuriaga, Arlene M; Mhlaba, Julie; Roman, Carly

    2016-06-01

    Dermatologic disease often presents in the primary care setting. Therefore, it is important for the primary care provider to be familiar with the presentation, diagnosis, and treatment of common skin conditions. This article provides an overview of acne, rosacea, melasma, vitiligo, alopecia, nonmelanoma, and melanoma skin cancer, dermatitis, and lichen sclerosus. PMID:27212088

  8. Impact of Chronic Conditions on the Cost of Cancer Care...

    Data.gov (United States)

    U.S. Department of Health & Human Services — According to findings reported in Impact of Chronic Conditions on the Cost of Cancer Care for Medicaid Beneficiaries, published in Volume 2, Issue 4 of the Medicare...

  9. Substitution of Hospital Care with Primary Care: Defining the Conditions of Primary Care Plus

    OpenAIRE

    van Hoof, Sofie Johanna Maria; Kroese, Mariëlle Elisabeth Aafje Lydia; Spreeuwenberg, Marieke Dingena; Elissen, Arianne Mathilda Josephus; Meerlo, Ronald Johan; Hanraets, Monique Margaretha Henriëtte; Ruwaard, Dirk

    2016-01-01

    Objective: To analyse barriers and facilitators in substituting hospital care with primary care to define preconditions for successful implementation.Methods: A descriptive feasibility study was performed to collect information on the feasibility of substituting hospital care with primary care. General practitioners were able to refer patients, about whom they had doubts regarding diagnosis, treatment and/or the need to refer to hospital care, to medical specialists who performed low-complex ...

  10. Sensitivity of a Simulated Derecho Event to Model Initial Conditions

    Science.gov (United States)

    Wang, Wei

    2014-05-01

    Since 2003, the MMM division at NCAR has been experimenting cloud-permitting scale weather forecasting using Weather Research and Forecasting (WRF) model. Over the years, we've tested different model physics, and tried different initial and boundary conditions. Not surprisingly, we found that the model's forecasts are more sensitive to the initial conditions than model physics. In 2012 real-time experiment, WRF-DART (Data Assimilation Research Testbed) at 15 km was employed to produce initial conditions for twice-a-day forecast at 3 km. On June 29, this forecast system captured one of the most destructive derecho event on record. In this presentation, we will examine forecast sensitivity to different model initial conditions, and try to understand the important features that may contribute to the success of the forecast.

  11. Working conditions in home care: a survey of Washington state's home care workers.

    Science.gov (United States)

    Hayashi, R; Gibson, J W; Weatherley, R A

    1994-01-01

    Home care services make it possible for millions of older Americans to continue living in the community. Such services may enhance the recipients' quality of life while providing essential respite to family caregivers. But while there has been increasing recognition of the burden borne by the predominantly female family caregivers, there has been less attention to the plight of the home care workforce. With the growth of the home care industry, the burden of care has to some extent shifted from one category of female caregivers to another. This paper, based on a survey of 16 agencies and 1,900 workers, examines the employment conditions of home care workers in Washington state. The study reveals a pattern of harsh working conditions, low wages, and few benefits. The findings raise questions about the ethics and efficacy of government policies that are based on the exploitation of home care workers. PMID:10134029

  12. Sensitivity of drainage efficiency of cranberry fields to edaphic conditions

    Science.gov (United States)

    Periard, Yann; José Gumiere, Silvio; Rousseau, Alain N.; Caron, Jean; Hallema, Dennis W.

    2014-05-01

    Water management on a cranberry farm requires intelligent irrigation and drainage strategies to sustain strong productivity and minimize environmental impact. For example, to avoid propagation of disease and meet evapotranspiration demand, it is imperative to maintain optimal moisture conditions in the root zone, which depends on an efficient drainage system. However, several drainage problems have been identified in cranberry fields. Most of these drainage problems are due to the presence of a restrictive layer in the soil profile (Gumiere et al., 2014). The objective of this work is to evaluate the effects of a restrictive layer on the drainage efficiency by the bias of a multi-local sensitivity analysis. We have tested the sensitivity of the drainage efficiency to different input parameters set of soil hydraulic properties, geometrical parameters and climatic conditions. Soil water flux dynamic for every input parameters set was simulated with finite element model Hydrus 1D (Simanek et al., 2008). Multi-local sensitivity was calculated with the Gâteaux directional derivatives with the procedure described by Cheviron et al. (2010). Results indicate that drainage efficiency is more sensitive to soil hydraulic properties than geometrical parameters and climatic conditions. Then, the geometrical parameters of the depth are more sensitive than the thickness. The drainage efficiency was very insensitive to the climatic conditions. Understanding the sensitivity of drainage efficiency according to soil hydraulic properties, geometrical and climatic conditions are essential for diagnosis drainage problems. However, it becomes important to identify the mechanisms involved in the genesis of anthropogenic soils cranberry to identify conditions that may lead to the formation of a restrictive layer. References: Cheviron, B., S.J. Gumiere, Y. Le Bissonnais, R. Moussa and D. Raclot. 2010. Sensitivity analysis of distributed erosion models: Framework. Water Resources Research

  13. Virtual Dementia Tour helps sensitize health care providers.

    Science.gov (United States)

    Beville, P K

    2002-01-01

    A review of the literature on sensitivity training among caregivers for the elderly revealed that no programs focused specifically on the cognitive changes that occur due to aging. Second Wind Dreams, a national nonprofit organization committed to improving society's perception of aging, conducted a study in which degenerative physical symptoms common for this population, such as impaired vision and motor skills, were simulated in a group of 146 subjects who worked in the field of elder care to give them a broader sense of the patient's perspective. Overwhelmingly, participants in the study came away with heightened awareness of the plight of confused elders and a strong sense that the high behavioral expectations caregivers have for dementia patients are unrealistic and need to change. PMID:12083349

  14. Concordance between nurse-reported quality of care and quality of care as publicly reported by nurse-sensitive indicators

    OpenAIRE

    Stalpers, Dewi; Kieft, Renate A. M. M.; Linden, Dimitri; Kaljouw, Marian J.; Schuurmans, Marieke J.

    2016-01-01

    Background Nurse-sensitive indicators and nurses’ satisfaction with the quality of care are two commonly used ways to measure quality of nursing care. However, little is known about the relationship between these kinds of measures. This study aimed to examine concordance between nurse-sensitive screening indicators and nurse-perceived quality of care. Methods To calculate a composite performance score for each of six Dutch non-university teaching hospitals, the percentage scores of the public...

  15. Sensitivity to Initial Conditions and Nonextensivity in Biological Evolution

    OpenAIRE

    Tamarit, Francisco A.; Cannas, Sergio A.; Tsallis, Constantino

    1996-01-01

    We consider biological evolution as described within the Bak and Sneppen 1993 model. We exhibit, at the self-organized critical state, a power-law sensitivity to the initial conditions, calculate the associated exponent, and relate it to the recently introduced nonextensive thermostatistics. The scenario which here emerges without tuning strongly reminds that of the tuned onset of chaos in say logistic-like onedimensional maps. We also calculate the dynamical exponent z.

  16. Dopaminergic sensitization in pigeons: conditioning and other influences

    OpenAIRE

    Keller, Sabine

    2001-01-01

    Apomorphine, a direct agonist of the neurotransmitter dopamine, elicits oral stereotypies when administered in low dosage. Pigeons react with longlasting bursts of pecks. When repeatedly administered a dose of apomorphine, pigeons show a behavioural sensitization expressed as an increasing pecking response to the drug. This increase is found to be partly dependent on conditioning to the environmental context in which apomorphine takes effect. The results of various experiments which led to th...

  17. Palliative Care, Hospice, and Advance Care Planning: Views of People Living with HIV and Other Chronic Conditions.

    Science.gov (United States)

    Slomka, Jacquelyn; Prince-Paul, Maryjo; Webel, Allison; Daly, Barbara J

    2016-01-01

    People living with HIV (PLWH) who survive to older adulthood risk developing multiple chronic medical conditions. Health policymakers recognize the role of early palliative care and advance care planning in improving health quality for at-risk populations, but misperceptions about palliative care, hospice, and advance care planning are common. Before testing a program of early palliative care for PLWH and other chronic conditions, we conducted focus groups to elicit perceptions of palliative care, hospice, and advance care planning in our target population. Overall, participants were unfamiliar with the term palliative care, confused concepts of palliative care and hospice, and/or associated hospice care with dying. Participants misunderstood advance care planning, but valued communication about health care preferences. Accepting palliative care was contingent on distinguishing it from hospice and historical memories of HIV and dying. Provision of high-quality, comprehensive care will require changing public perceptions and individuals' views in this high-risk population. PMID:27053406

  18. Conditional nonlinear optimal perturbation: Applications to stability, sensitivity, and predictability

    Institute of Scientific and Technical Information of China (English)

    DUAN WanSuo; MU Mu

    2009-01-01

    Conditional nonlinear optimal perturbation (CNOP) is a nonlinear generalization of linear singular vec-tor (LSV) and features the largest nonlinear evolution at prediction time for the initial perturbations in a given constraint. It was proposed initially for predicting the limitation of predictability of weather or climate. Then CNOP has been applied to the studies of the problems related to predictability for weather and climate. In this paper, we focus on reviewing the recent advances of CNOP's applications,which involves the ones of CNOP in problems of ENSO amplitude asymmetry, block onset, and the sensitivity analysis of ecosystem and ocean's circulations, etc. Especially, CNOP has been primarily used to construct the initial perturbation fields of ensemble forecasting, and to determine the sensitive area of target observation for precipitations. These works extend CNOP'a applications to investigating the nonlinear dynamical behaviors of atmospheric or oceanic systems, even a coupled system, and studying the problem of the transition between the equilibrium states. These contributions not only attack the particular physical problems, but also show the superiority of CNOP to LSV in revealing the effect of nonlinear physical processes. Consequently, CNOP represents the optimal precursors for a weather or climate event; in predictability studies, CNOP stands for the initial error that has the largest negative effect on prediction; and in sensitivity analysis, CNOP is the most unstable (sensitive) mode.In multi-equilibrium state regime, CNOP is the initial perturbation that induces the transition between equilibriums most probably. Furthermore, CNOP has been used to construct ensemble perturbation fields in ensemble forecast studies and to identify sensitive area of target observation. CNOP theory has become more and more substantial. It is expected that CNOP also serves to improve the predict-ability of the realistic predictions for weather and climate events

  19. Conditional nonlinear optimal perturbation: Applications to stability, sensitivity, and predictability

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    Conditional nonlinear optimal perturbation (CNOP) is a nonlinear generalization of linear singular vector (LSV) and features the largest nonlinear evolution at prediction time for the initial perturbations in a given constraint. It was proposed initially for predicting the limitation of predictability of weather or climate. Then CNOP has been applied to the studies of the problems related to predictability for weather and climate. In this paper, we focus on reviewing the recent advances of CNOP’s applications, which involves the ones of CNOP in problems of ENSO amplitude asymmetry, block onset, and the sensitivity analysis of ecosystem and ocean’s circulations, etc. Especially, CNOP has been primarily used to construct the initial perturbation fields of ensemble forecasting, and to determine the sensitive area of target observation for precipitations. These works extend CNOP’s applications to investigating the nonlinear dynamical behaviors of atmospheric or oceanic systems, even a coupled system, and studying the problem of the transition between the equilibrium states. These contributions not only attack the particular physical problems, but also show the superiority of CNOP to LSV in revealing the effect of nonlinear physical processes. Consequently, CNOP represents the optimal precursors for a weather or climate event; in predictability studies, CNOP stands for the initial error that has the largest negative effect on prediction; and in sensitivity analysis, CNOP is the most unstable (sensitive) mode. In multi-equilibrium state regime, CNOP is the initial perturbation that induces the transition between equilibriums most probably. Furthermore, CNOP has been used to construct ensemble perturbation fields in ensemble forecast studies and to identify sensitive area of target observation. CNOP theory has become more and more substantial. It is expected that CNOP also serves to improve the predictability of the realistic predictions for weather and climate

  20. Nurse-sensitive health care outcomes in acute care settings: an integrative analysis of the literature.

    Science.gov (United States)

    Pierce, S F

    1997-04-01

    With the advent of profit maximization in health care came an increased focus on defining quality through outcomes achieved. The article describes an analysis of the nursing literature from 1974 to 1996 using Donabedian's structure-process-outcome framework and the specific indicators identified by the American Nurses Association report card, the Institute of Medicine, and the nursing-sensitive outcomes classification. Although evidence exists documenting nursing's positive impact on patient outcomes, this analysis suggests a real need to integrate our clinical and administrative studies and to employ a more comprehensive, longitudinal, multifacility approach if we are to answer the scientific question regarding which nursing structures and processes truly produce the best health outcomes. PMID:9097521

  1. Conceptual and methodological aspects in the study of hospitalizations for ambulatory care sensitive conditions Aspectos conceituais e metodológicos no estudo das hospitalizações por condições sensíveis à atenção primária

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2011-01-01

    Full Text Available Hospitalization rates for Ambulatory Care Sensitive Conditions have been used to assess effectiveness of the first level of health care. From a critical analysis of related concepts, we discuss principles for selecting a list of codes and, taking the example of the Brazilian Family Health Program, propose a methodological pathway for identifying variables in order to inform statistical models of analysis. We argue that for the indicator to be comparable between regions, disease codes should be selected based on sensitivity and specificity principles, not on observed disease frequency. Rates of hospitalization will be determined, at a distal level, by the socio-economic environment and their effect on the social and demographic structure. Timely and effective care depends on the organization of health services, their availability and access barriers, which depend on the ways health and related technology are conceptualised and on their adherence to the biomedical model or to the Primary Health Care (PHC principles; performance indicators of the health system will be the proximal determinants. This indicator is potentially useful for primary care evaluation. The historical reconstruction of PHC improves the analysis of the indicator variability.As taxas de hospitalização por condições sensíveis à atenção primária são um indicador da efetividade do primeiro nível de atenção à saúde. Partindo de breve revisão crítica, este artigo discute princípios para a seleção de códigos de internação por essas causas e, com o exemplo do Programa Saúde da Família, propõe um modelo teórico para a seleção de variáveis para análise estatística. A comparabilidade inter-regional do indicador depende da seleção de códigos de doenças baseada em princípios de sensibilidade e especificidade, não na frequência da doença. As taxas de hospitalização serão distalmente determinadas pela situação socioeconômica e seu efeito sobre a

  2. Assessing decision quality in patient-centred care requires a preference-sensitive measure

    DEFF Research Database (Denmark)

    Kjer Kaltoft, Mette; Cunich, Michelle; Salkeld, Glenn;

    2014-01-01

    decision making by calculating, for each criterion, the Incremental Value of Perfect Rating, that is, the increase in their decision quality score that would result if their performance rating on the criterion had been 100%, weightings unchanged. MyDecisionQuality, which is a web-based generic and...... aspects of decision making. Current instruments using the term 'decision quality' have adopted a decision- and thus condition-specific approach. We argue that patient-centred care requires decision quality to be regarded as both preference-sensitive across multiple relevant criteria and generic across all...... preference-sensitive instrument, can constitute a key patient-reported measure of the quality of the decision-making process. It can provide the basis for future decision improvement, especially when the clinician (or other stakeholders) completes the equivalent instrument and the extent and nature of...

  3. Sensitivity of African easterly waves to boundary layer conditions

    Directory of Open Access Journals (Sweden)

    A. Lenouo

    2008-06-01

    Full Text Available A linearized version of the quasi-geostrophic model (QGM with an explicit Ekman layer and observed static stability parameter and profile of the African easterly jet (AEJ, is used to study the instability properties of the environment of the West African wave disturbances. It is found that the growth rate, the propagation velocity and the structure of the African easterly waves (AEW can be well simulated. Two different lower boundary conditions are applied. One assumes a lack of vertical gradient of perturbation stream function and the other assumes zero wind perturbation at the surface. The first case gives more realistic results since in the absence of horizontal diffusion, growth rate, phase speed and period have values of 0.5 day−1, 10.83 m s−1 and 3.1 day, respectively. The zero wind perturbation at the surface case leads to values of these parameters that are 50 percent lower. The analysis of the sensitivity to diffusion shows that the magnitude of the growth rate decreases with this parameter. Modelled total relative vorticity has its low level maximum around 900 hPa under no-slip, and 700 hPa under free slip condition.

  4. Sensitivity of African easterly waves to boundary layer conditions

    Energy Technology Data Exchange (ETDEWEB)

    Lenouo, A. [Douala Univ. (Cameroon). Dept. of Physics; Mkankam Kamga, F. [Yaounde I Univ. (Cameroon). LEMAP, Dept. of Physics

    2008-07-01

    A linearized version of the quasi-geostrophic model (QGM) with an explicit Ekman layer and observed static stability parameter and profile of the African easterly jet (AEJ), is used to study the instability properties of the environment of the West African wave disturbances. It is found that the growth rate, the propagation velocity and the structure of the African easterly waves (AEW) can be well simulated. Two different lower boundary conditions are applied. One assumes a lack of vertical gradient of perturbation stream function and the other assumes zero wind perturbation at the surface. The first case gives more realistic results since in the absence of horizontal diffusion, growth rate, phase speed and period have values of 0.5 day{sup -1}, 10.83 m s{sup -1} and 3.1 day, respectively. The zero wind perturbation at the surface case leads to values of these parameters that are 50 percent lower. The analysis of the sensitivity to diffusion shows that the magnitude of the growth rate decreases with this parameter. Modelled total relative vorticity has its low level maximum around 900 hPa under no-slip, and 700 hPa under free slip condition. (orig.)

  5. COMPUTATIONAL FLUID DYNAMICS BASED INVESTIGATION OF SENSITIVITY OF FURNACE OPERATIONAL CONDITIONS TO BURNER FLOW CONTROLS

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Zumao Chen; Dave Wang; Paul Wolff

    2004-06-01

    This is the extended second Semiannual Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project is to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. Our approach is to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner flow controls. The Electric Power Research Institute (EPRI) is providing co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center are active participants in this project. This program contains multiple tasks and good progress is being made on all fronts.

  6. Sensitivity studies of a PCV under earthquake loading conditions

    International Nuclear Information System (INIS)

    Pressure containment vessels (PCV) of nuclear power plants are designed to withstand loadings due to normal operation as well as internal and external events. Their design underlies more stringent regulatory requirements and licensing conditions than that imposed for conventional or civil engineering structures. External events are initiated outside of the plant and include aircraft impact, explosion pressure waves just as earthquake. Stress resultants due to seismic loads are normally calculated by modal analysis, using broadened and smoothed acceleration response spectra. Since temporal combination of modes and directions are considered by time history method, it is used to get more precise results. However, these calculations are very sensitive and there is a lack of more precise general statements in literature and regulations, especially for PCV. The aim was to get an equivalence to the safety-margin e.g. received in modal analysis by broadening and smoothing the spectra according to regulations. Therefore influencing values have been varied in several calculations to point out their effects. The most important results are presented in this paper

  7. Noise sensitivity and reactions to noise and other environmental conditions

    NARCIS (Netherlands)

    Miedema, H.M.E.; Vos, H.

    2003-01-01

    This article integrates findings from the literature and new results regarding noise sensitivity. The new results are based on analyses of 28 combined datasets (N=23 038), and separate analyses of a large aircraft noise study (N=10939). Three topics regarding noise sensitivity are discussed, namely,

  8. Talking about sensitive topics during the advance care planning discussion: A peek into the black box

    DEFF Research Database (Denmark)

    Andreassen, Pernille; Neergaard, Mette Asbjørn; Brogaard, Trine; Skorstengaard, Marianne Hjorth; Jensen, Anders Bonde

    2015-01-01

    OBJECTIVE: Advance care planning (ACP) discussions are emphasized as a valuable way of improving communication about end-of-life care. Yet we have very little knowledge of what goes on during actual ACP discussions. The aim of our study was to explore how the sensitive topics of end-of-life decis...

  9. Spanning boundaries and creating strong patient relationships to coordinate care are strategies used by experienced chronic condition care coordinators.

    Science.gov (United States)

    Ehrlich, Carolyn; Kendall, Elizabeth; Muenchberger, Heidi

    2012-08-01

    People with complex chronic conditions frequently need to navigate their own way through and around a fragmented and siloed health care system. Care coordination is a defining principle of primary care and is frequently proposed as a solution to this problem. However, care coordination requires more time and effort than primary care physicians alone have the capacity to deliver. Although registered nurses (RNs) are skilled team members who can be included in the delivery of coordinated patient care, any model of care coordination that involves RNs needs to fit within the existing health care delivery system. In this study, which used qualitative techniques based on grounded theory and included face-to-face interviews and open coding and theoretical sampling until data saturation was achieved, and which was one component of a larger action research study, we aimed to gain an understanding of the difference between usual chronic condition care and the work of chronic condition care coordination. The researchers interviewed general practitioners and RNs from various general practice sites who were actively coordinating care. Four unique processes were found to define care coordination implementation, namely: (1) moving beyond usual practice by spanning boundaries; (2) relationship-based care; (3) agreed roles and routines among relevant parties; and (4) committing to chronic condition care coordination. The findings suggested that existing professional and organisational cultures required negotiation before care coordination could be integrated into existing contexts. The challenge, however, seems to be in acknowledging and overcoming professional practice boundaries that define existing care through reflective practice and shared resourcing. PMID:23050573

  10. Nonmaternal Care's Association With Mother's Parenting Sensitivity: A Case of Self-Selection Bias?

    Science.gov (United States)

    Nomaguchi, Kei M; Demaris, Alfred

    2013-06-01

    Although attachment theory posits that the use of nonmaternal care undermines quality of mothers' parenting, empirical evidence for this link is inconclusive. Using data from the National Institute of Child Health and Human Development Study of Early Child Care and Youth Development (N = 1,233), the authors examined the associations between nonmaternal care characteristics and maternal sensitivity during the first 3 years of children's lives, with special attention to selection effects and moderation by resource levels. Findings from fixed-effects regression models suggested that, on average, there is little relationship between nonmaternal care characteristics and maternal sensitivity, once selection factors are held constant. Some evidence of moderation effects was found, however. Excellent-quality care is related to more sensitivity for mothers with lower family income. Poor-quality care is related to lower sensitivity for single mothers, but not partnered mothers. In sum, nonmaternal care characteristics do not seem to have as much influence on mothers' parenting as attachment theory claims. PMID:23772093

  11. Co-ordination and management of chronic conditions in Europe : the role of primary care.

    NARCIS (Netherlands)

    Gress, S.; Baan, C.A.; Calnan, M.; Dedeu, T.; Groenewegen, P.P.; Howson, H.

    2009-01-01

    Healthcare systems in Europe struggle with inadequate co-ordination of care for people with chronic conditions. Moreover, there is a considerable evidence gap in the treatment of chronic conditions, lack of self-management, variation in quality of care, lack of preventive care, increasing costs for

  12. Migrants' and professionals' views on culturally sensitive pre-hospital emergency care.

    Science.gov (United States)

    Kietzmann, Diana; Hannig, Christian; Schmidt, Silke

    2015-08-01

    This study was designed to explore the views of migrants and professionals on culturally sensitive pre-hospital emergency care in order to adapt such care to migrants' needs. Interviews were conducted with 41 migrants who had received direct (as a patient) or indirect (as a significant other) pre-hospital emergency care. Furthermore, 20 professionals in the field of pre-hospital emergency care were interviewed. The content analysis showed five distinguishable categories based on the statements by the migrants and six categories based on the statements by the professionals. While migrants gave priority to basic proficiencies of first responders such as 'social/emotional competencies' and 'communication skills', the professionals considered '(basic) cultural knowledge', 'awareness' and 'attitude' the most important. Furthermore, migrants provided practical indications, e.g. regarding areas of cultural knowledge, whereas professionals seemed to view the issue of culturally pre-hospital emergency care from a more theoretical perspective. The issues of the culturally sensitive pre-hospital emergency care itself, as well as the varying points of view of the two groups interviewed, resulted in eight recommendations for culturally sensitive pre-hospital emergency care. PMID:26123882

  13. Chronic Exercise Increases Sensitivity to the Conditioned Rewarding Effects of Cocaine

    OpenAIRE

    Smith, Mark A.; Gergans, Samantha R.; Iordanou, Jordan C.; Lyle, Megan A.

    2008-01-01

    The purpose of this study was to determine whether chronic exercise alters sensitivity to the conditioned rewarding effects of cocaine. Female rats were obtained at weaning and randomly assigned to either sedentary or exercise conditions. After 6 weeks under these conditions, the effects of cocaine were examined in the conditioned place preference procedure. Cocaine produced a dose-dependent conditioned place preference in both groups of rats. Exercising rats were more sensitive than sedentar...

  14. [Skin sensitizers in cosmetics and skin care products].

    Science.gov (United States)

    Minamoto, Keiko

    2010-01-01

    Cosmetics are defined as "articles with mild action on the human body, which are intended to be applied to the human body through rubbing, sprinkling or other methods, aiming to clean, beautify and increase the attractiveness, alter the appearance or to keep the skin or hair in good condition (The Pharmaceutical Affairs Law: Article 2)." Consequently, they include personal hygiene products such as shampoos, soaps and toothpaste. In Europe, 1% of the population is estimated to be allergic to fragrances and 2-3% to ingredients of cosmetics; 10% of outpatients patch-tested for cosmetics allergy were found to be positive. Allergenic ingredients of cosmetics can be fragrances, hair dye, preservatives, antioxidants, emollients, surfactants, UV absorbers, pigments or resins used in nail cosmetics. Among standard allergen series, eight substances are related to cosmetics; in Japan in 2003, p-phenylenediamine (hair dyes) induced allergic reactions with the highest rate of 7.9% in outpatients patch-tested (n=805), followed by fragrance mix No. 1 (4.0%, mixture of eight fragrances frequently used), colophony (3.2%, main contents of pine resin), lanolin alcohol (2.7%,emollients), and formaldehyde, parabens, Kathon CG (2.7% ,1.9% and 1.0%, respectively; preservatives). Cosmetic allergy symptoms tend to be mild except those caused by hair dye. However, the population exposed to cosmetics is huge and the number of ingredients used in cosmetics increased up to more than 6000. Here, major cosmetic ingredient allergens, mainly reported in Japan, are reviewed and discussed. PMID:20134105

  15. Computational Fluid Dynamics Based Investigation of Sensitivity of Furnace Operational Conditions to Burner Flow Controls

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Kirsi St. Marie; Dave Wang

    2003-04-30

    This is the first Semiannual Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project is to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. Our approach is to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner flow controls. The Electric Power Research Institute (EPRI) is providing co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center are active participants in this project. This program contains multiple tasks and good progress is being made on all fronts. A project kickoff meeting was held in conjunction with NETL's 2002 Sensors and Control Program Portfolio Review and Roadmapping Workshop, in Pittsburgh, PA during October 15-16, 2002. Dr. Marc Cremer, REI, and Dr. Paul Wolff, EPRI I&C, both attended and met with the project COR, Susan Maley. Following the review of REI's database of wall-fired coal units, the project team selected a front wall fired 150 MW unit with a Riley Low NOx firing system including overfire air for evaluation. In addition, a test matrix outlining approximately 25 simulations involving variations in burner secondary air flows, and coal and primary air flows was constructed. During the reporting period, twenty-two simulations have been completed, summarized, and tabulated for sensitivity analysis. Based on these results, the team is developing a suitable approach for quantifying the sensitivity coefficients associated with the parametric tests. Some of the results of the CFD

  16. Sensitivity of African easterly waves to boundary layer conditions

    OpenAIRE

    A. Lenouo; Mkankam Kamga, F.

    2008-01-01

    A linearized version of the quasi-geostrophic model (QGM) with an explicit Ekman layer and observed static stability parameter and profile of the African easterly jet (AEJ), is used to study the instability properties of the environment of the West African wave disturbances. It is found that the growth rate, the propagation velocity and the structure of the African easterly waves (AEW) can be well simulated. Two different lower boundary conditions are applied. One assumes a lack of vertical g...

  17. Relationship among eye condition sensitivities,photosensitivity and epileptic syndromes

    Institute of Scientific and Technical Information of China (English)

    YANG Zhi-xian; CAI Xiang; LIU Xiao-yan; QIN Jiong

    2008-01-01

    Background Electroencephalogram(EEG)activity in normal subjects and epileptic patients is often closely related to the eye's status such as eye opened(EO),eye closure(ECL)and eyes closed(EC).ECL is the period immediately after closing of the eyes and only Iasts for Jess than 3 seconds if the eyes remain closed.EC is the pened as long as the eyes are closed.Epileptiform changes on EEG induced by ECL or EC are called the changes of ECL sensitivity(ECLS)or EC sensitivity (ECS).ECLS occurs mainly but not exclusively in photosensitive patients and ECS has been seen rarely in photosensitive patients.This study aimed to investigate the relationships among ECLS,ECS.photosensitivity and epilepsy syndromes in children.Methods EEG records from child patients in the EEG Department of Peking University First Hospital dudng the period of May 2005 to Mav 2007 were examined for the presence of ECLS or ECS.Open-close eye tests and intermittent photic stimulations were carried out during video-EEG monitoring for examining ECLS.ECS and photosensitivity.Results Based on ECLS and ECS on their EEGs,30 patients were divided into ECLS group (16 cases)and ECS group (14 cases).There were more boys than girls in the two groups.The mean age of initial detection of ECLS and ECS was 10 years.and the average onset age of seizures was 9 years.The epilepsy syndromes in the ECLS group included idiopathic photosensitive occipital lobe epilepsy,Panayiotopoulos syndrome,symptomatic occipital lobe epilepsy,juvenile myoclonic epilepsy,juvenile absence epilepsy,eyelid myoclonia with absences,epilepsy with grand mal on awakening and pure photosensitive epilepsy with mainly generalized tonic clonic seizures.Those in the ECS group were iuvenile myoclonic epilepsy,idiopathic photosensitive occipital Iobe epilepsy,Panayiotopoulos syndrome and Gastaut type-idiclpathic children occipital epilepsy.Photosensitivity was detected in 88%of Patients with ECLS and 29%of patients with ECS.Conclusions ECLS and ECS are

  18. Programa Saúde da Família e condições sensíveis à atenção primária, Bagé (RS Programa Salud de la Familia y condiciones sensibles a la atención primaria, Sur de Brasil Family Health Program and ambulatory care-sensitive conditions in Southern Brazil

    Directory of Open Access Journals (Sweden)

    Fúlvio Borges Nedel

    2008-12-01

    familia, ser usuaria del Programa Salud de la Familia, consulta médica en la emergencia en el mes anterior a la investigación y hospital de internación; b hombres: rango de edad, haber sufrido otra internación en el año anterior a la entrevista y el hospital de internación. CONCLUSIONES: Las condiciones sensibles a la atención primaria permiten identificar grupos carentes de atención a la salud adecuada. A pesar de que el estudio no permita hacer inferencias sobre el riesgo de internación, los análisis por sexo y modelo de atención sugieren que el programa Salud de la Familia es más equitativo que la atención básica tradicional.OBJECTIVE: Ambulatory care-sensitive conditions (ACSC are health problems managed by actions at the first level of care. The need for hospitalization by these causes is avoidable through an effective and proper primary health care. The objective of the study was to estimate ACSC among patients hospitalized by the Sistema Único de Saúde (Brazilian Health System. METHODS: Hospital-based cross-sectional study involving 1,200 inhabitants of Bagé (Southern Brazil who were inpatients between September/2006 and January/2007. The patients answered a questionnaire applied by interviewers and were classified according to the model of attention utilized prior to hospitalization. ACSC were defined in a workshop promoted by the Ministry of Health. The variables analyzed included demographic and socioeconomic characteristics, health and health services utilized. Multivariate analysis was conducted by the Poisson model, according to a hierarchical conceptual framework, stratified by sex and model of care. RESULTS: ACSC accounted for 42.6% of the hospitalizations. The probability that the main diagnosis for hospitalization is considered an ACSC is greater among women, children under five years of age, individuals with less then five years of schooling, hospitalization in the year prior to the interview, emergency room consultation, and being an

  19. Conditions of Caregiving, Provider Nurturance, and Quality Care

    OpenAIRE

    Austin, Ann Marie Berghout; Lindauer, Shelley L. Knudsen; Rodriquez, Ariel; Nortion, Maria L.; Nelson, Farol A. Groutage

    1997-01-01

    Participants included 36 licensed family day care providers from six rural counties who had been providing care for a mean of 8.3 years (SO = 6.8 years). Fourteen of the providers had earned high school diplomas; twenty‐two had some post high school education. At least one child from an economically strained home (as measured by AFDC receipt) was present in 44.4% of the FDC homes. Dependent measures included: The Caregiver Interaction Scale (Arnett, 1989); Elaboration Scale from The Family Da...

  20. Minimally Disruptive Medicine: A Pragmatically Comprehensive Model for Delivering Care to Patients with Multiple Chronic Conditions

    OpenAIRE

    Leppin, Aaron L; Victor M Montori; Gionfriddo, Michael R

    2015-01-01

    An increasing proportion of healthcare resources in the United States are directed toward an expanding group of complex and multimorbid patients. Federal stakeholders have called for new models of care to meet the needs of these patients. Minimally Disruptive Medicine (MDM) is a theory-based, patient-centered, and context-sensitive approach to care that focuses on achieving patient goals for life and health while imposing the smallest possible treatment burden on patients’ lives. The MDM Care...

  1. Basic Conditioning Factors' Influences on Adolescents' Healthy Behaviors, Self-Efficacy, and Self-Care

    OpenAIRE

    Callaghan, Donna

    2006-01-01

    This article reports a secondary statistical analysis of data from a study investigating the relationships among health-promoting self-care behaviors, self-care self-efficacy, and self-care agency in an adolescent population (Callaghan, 2005). The purpose of this study was to identify the influences of selected basic conditioning factors on the practice of healthy behaviors, self-efficacy beliefs, and ability for self-care in 256 adolescents. The research instruments used to collect data for ...

  2. Older South Asian patient and carer perceptions of culturally sensitive care in a community hospital setting.

    Science.gov (United States)

    Clegg, Angie

    2003-03-01

    This study describes the application of grounded theory to establish older, south Asian patient and carer views of service delivery in the UK. The purpose of the study was to inform the development of culturally sensitive services by defining the concept of cultural sensitivity from a user/carer perspective. The study took place in two community hospitals providing nurse-led intermediate care to a culturally diverse inner city population. Fifty-five per cent of the inner city population is of south Asian origin. Admissions to intermediate care, however, do not reflect the demography. Recent reports commissioned by the Department of Health highlight the failure of the National Health Service in England to provide culturally sensitive services to black and Asian patients. The Department of Health is trying to redress this inequality providing policy guidance for improving access and cultural sensitivity in the British health care system. There is little existing empirical evidence, however, to clarify the concept of culturally sensitive care. Patients and carers in this study described culturally appropriate care as that which respects individuality, creates mutual understanding, caters for spiritual need and maintains dignity. Older south Asian patients and their carers identified respect, understanding, spirituality and dignity as central to their conceptualization of cultural sensitivity. Their focus was on the nature of human relationships and their ability to interact in a positive way with staff. The findings of this small piece of empirical research are limited by the sample size (four patients and three carers), but illustrate that cultural sensitivity, although complex, can be defined. This then provides a basis for developing appropriate care strategies. One universal principle explicit in this research was that to be sensitive to culture staff must challenge their own assumptions and develop an understanding of the many layers of culture and subculture

  3. Key Concepts for Estimating the Burden of Surgical Conditions and the Unmet Need for Surgical Care

    OpenAIRE

    Bickler, Stephen; Ozgediz, Doruk; Gosselin, Richard; Spiegel, David; Hsia, Renee; Dunbar, Peter; McQueen, Kelly; Jamison, Dean; Weiser, Thomas Geoghegan

    2010-01-01

    Background: Surgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective. Methods: A consensus opinion of a group of surgeons, anesthesiologists, and public health experts was established regarding the methodology for estimating the burden of surgical conditions and the unmet need for surgical care. Results: For purposes of analysis, we define surgical conditions as any disease state requirin...

  4. Computational Fluid Dynamics Based Investigation of Sensitivity of Furnace Operational Conditions to Burner Flow Controls

    Energy Technology Data Exchange (ETDEWEB)

    Marc Cremer; Dave Wang; Connie Senior; Andrew Chiodo; Steven Hardy; Paul Wolff

    2005-07-01

    This is the Final Technical Report for DOE Cooperative Agreement No: DE-FC26-02NT41580. The goal of this project was to systematically assess the sensitivity of furnace operational conditions to burner air and fuel flows in coal fired utility boilers. The focus of this project was to quantify the potential impacts of ''fine level'' controls rather than that of ''coarse level'' controls (i.e. combustion tuning). Although it is well accepted that combustion tuning will generally improve efficiency and emissions of an ''out of tune'' boiler, it is not as well understood what benefits can be derived through active multiburner measurement and control systems in boiler that has coarse level controls. The approach used here was to utilize existing baseline furnace models that have been constructed using Reaction Engineering International's (REI) computational fluid dynamics (CFD) software. Using CFD analyses provides the ability to carry out a carefully controlled virtual experiment to characterize the sensitivity of NOx emissions, unburned carbon (UBC), furnace exit CO (FECO), furnace exit temperature (FEGT), and waterwall deposition to burner air and fuel flow rates. The Electric Power Research Institute (EPRI) provided co-funding for this program, and instrument and controls experts from EPRI's Instrument and Controls (I&C) Center have been active participants in this project. CFD simulations were completed for five coal fired boilers as planned: (1) 150 MW wall fired, (2) 500 MW opposed wall fired, (3) 600 MW T-Fired, (4) 330 MW cyclone-fired, and (5) 200 MW T-Fired Twin Furnace. In all cases, the unit selections were made in order to represent units that were descriptive of the utility industry as a whole. For each unit, between 25 and 44 furnace simulations were completed in order to evaluate impacts of burner to burner variations in: (1) coal and primary air flow rate, and (2) secondary air flow

  5. Integrated care for childhood epilepsy: ongoing challenges and lessons for other long-term conditions

    OpenAIRE

    Bali, A; Cross, H.; Lakhanpaul, M.; Hargreaves, D.; Cowman, J; Power, M; Dunkley, C.

    2016-01-01

    Epilepsy care has been identified as a major global issue – and there are many recognised concerns in the UK for children and young people with the condition. A proposed new model could help to increase multi-sector integration, facilitate better outcomes, and offer lessons for improving care of other long-term conditions.

  6. Phase matching condition for enhancement of phase sensitivity in quantum metrology

    OpenAIRE

    Jing LIU; Jing, Xiaoxing; Wang, Xiaoguang

    2013-01-01

    We find a phase matching condition for enhancement of sensitivity in a Mach-Zehnder interferometer illuminated by an arbitrary state in one input port and an odd(even) state in the other port. Under this condition, the Fisher information becomes maximal with respect to the relative phase of two modes and the phase sensitivity is enhanced. For the case with photon losses, we further find that the phase matching condition keeps unchanged with a coherent state and a coherent superposition state ...

  7. Latex sensitization in health care workers and in the US general population.

    Science.gov (United States)

    Garabrant, D H; Roth, H D; Parsad, R; Ying, G S; Weiss, J

    2001-03-15

    Sensitization to natural rubber latex is a prerequisite to type I immediate hypersensitivity reactions (urticaria, angioedema, anaphylaxis, and allergic rhinitis) that result from subsequent latex exposure. This study examines occupations in which latex glove use is common to determine whether it is associated with increased prevalence odds of latex sensitization (measured by latex-specific immunoglobulin E antibodies) by using data from 5,512 adults aged 17--60 years from the Third National Health and Nutrition Examination Survey (1988--1991). After other factors associated with latex sensitization were controlled for, there was a nonsignificant association between longest-held jobs in health care and latex sensitization (odds ratio (OR) = 1.49, 95 percent confidence interval (CI): 0.92, 2.40). For current occupations, latex sensitization was not associated with health care work in which gloves were used (OR = 1.17, 95 percent CI: 0.51, 2.65) or with other occupations in which latex glove use is common (OR = 1.01, 95 percent CI: 0.49, 2.07) compared with other occupations. Current health care workers who reported not using gloves were at increased risk of latex sensitization, both among those without a history of childhood atopy (OR = 2.30, 95 percent CI: 1.04, 5.13) and those with such a history (OR = 28.04, 95 percent CI: 3.64, 215.97). This odds ratio heterogeneity suggests that subjects with childhood atopy may be at high risk of latex sensitization. PMID:11257057

  8. Challenges to culturally sensitive care for elderly chinese patients: a first-generation Chinese-American perspective.

    Science.gov (United States)

    Chan, Karen C

    2013-01-01

    Physicians and medical institutions in the United States are placing increasing emphasis on providing culturally sensitive care for patients, such as implementing a Confucian family-based model of medical decision making when caring for elderly Chinese patients. In this article, I articulate various reasons why deferring to the family is not a guarantee of culturally sensitive care, particularly when family members are first-generation Chinese-Americans. Nonetheless, I offer several suggestions to help physicians, medical institutions, and family members to provide more culturally sensitive care for elderly Chinese patients. PMID:24597422

  9. The Burnout Condition of Primary Health Care Personnel

    Directory of Open Access Journals (Sweden)

    Mehmet Kaya

    2007-10-01

    Full Text Available The concept of burnout was first introduced by Fredeunberger in 1974. Fredeunberger had stated that burnout occurred more commonly in occupations whose members directly work with people. The aim of the study is to examine the burnout status of primary health care staff. The universe of this descriptive study is 466 health staff who work in primary health care units in Kecioren. The participation of the study was 54%. A Questionnaire including Maslach Burnout Inventory (MBI and some characteristics of the participants were used for data collection. Mann-whitney U and Kruskal Wallis tests have been used for analizing the survey data. Seventyseven percent of the participants were female and the emotional exhaustion score of female was higher than male (p<0.01. The age of the participants effect the individual achievement scores (p<0.01. The profession or marital status of the participants didn’t affect the MBI scores. Some socio-demografic characteristics of the participants such as gender and age, affect the scores of MBI. Comprehensive studies which display the causes of problems, needed in this issue. [TAF Prev Med Bull. 2007; 6(5: 357-363

  10. The Burnout Condition of Primary Health Care Personnel

    Directory of Open Access Journals (Sweden)

    Mehmet Kaya

    2007-10-01

    Full Text Available The concept of burnout was first introduced by Fredeunberger in 1974. Fredeunberger had stated that burnout occurred more commonly in occupations whose members directly work with people. The aim of the study is to examine the burnout status of primary health care staff. The universe of this descriptive study is 466 health staff who work in primary health care units in Kecioren. The participation of the study was 54%. A Questionnaire including Maslach Burnout Inventory (MBI and some characteristics of the participants were used for data collection. Mann-whitney U and Kruskal Wallis tests have been used for analizing the survey data. Seventyseven percent of the participants were female and the emotional exhaustion score of female was higher than male (p<0.01. The age of the participants effect the individual achievement scores (p<0.01. The profession or marital status of the participants didn’t affect the MBI scores. Some socio-demografic characteristics of the participants such as gender and age, affect the scores of MBI. Comprehensive studies which display the causes of problems, needed in this issue. [TAF Prev Med Bull 2007; 6(5.000: 357-363

  11. Why should a birational geometer care about Bridgeland stability conditions?

    OpenAIRE

    Fontanari, Claudio; Martinelli, Diletta

    2016-01-01

    In this survey we borrow from Coskun and Huizenga an example of application of Bridgeland stability conditions to birational geometry and we rephrase it without assuming any previous knowledge about derived categories.

  12. Physicians' Psychosocial Work Conditions and Quality of Care: A Literature Review

    Directory of Open Access Journals (Sweden)

    Peter Angerer

    2015-05-01

    Full Text Available Background: Physician jobs are associated with adverse psychosocial work conditions. We summarize research on the relationship of physicians' psychosocial work conditions and quality of care. Method: A systematic literature search was conducted in MEDLINE and PsycINFO. All studies were classified into three categories of care quality outcomes: Associations between physicians' psychosocial work conditions and (1 the physician-patient-relationship, or (2 the care process and outcomes, or (3 medical errors were examined. Results: 12 publications met the inclusion criteria. Most studies relied on observational cross-sectional and controlled intervention designs. All studies provide at least partial support for physicians’ psychosocial work conditions being related to quality of care. Conclusions: This review found preliminary evidence that detrimental physicians’ psychosocial work conditions adversely influence patient care quality. Future research needs to apply strong designs to disentangle the indirect and direct effects of adverse psychosocial work conditions on physicians as well as on quality of care.Keywords: psychosocial work conditions, physicians, quality of care, physician-patient-relationship, hospital, errors, review, work stress, clinicians

  13. Generalizing the Sensitivity Conditions in an Overall Index of Product Quality.

    OpenAIRE

    Praveen K. Kopalle; Donna L. Hoffman

    1992-01-01

    The issue of the sensitivity of weighted linear composites to attribute-importance weights has attracted researchers from various disciplines, including marketing, psychology, and statistics. At issue is how sensitive a weighted scale is to a particular choice of weights. Scale sensitivity is defined by a negative correlation between two scales. By considering the general case of "n" attributes and using an algebraic approach, the authors specify the precise sufficiency conditions under which...

  14. BACTERIAL SPECTRUM AND PATTERN OF ANTIMICROBIAL SENSITIVITY AMONG OUTPATIENTS WITH PNEUMONIA IN A TERTIARY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Sushma

    2015-04-01

    Full Text Available OBJECTIVES: To outline the spectrum of bacteria causing pneumonia and the pattern of antimicrobial sensitivity in outpatients with pneumonia in a tertiary care hospital in Himachal Pradesh. METHODS: Sputum of 108 immuno competent pneumonia patients attending outpatient departments of Medicine and Pulmonary medicine of Dr. R. P. Government Medical College , Kangra at Tanda was sent for Gram staining and culture and sensitivity testing. RESULTS: Commensals were detected in most of the cases (32 , 29.6% followed by Staphylococcus aureus in 17(15.7% and Streptococcus pneumoniae in 16(14.8%. This was followed by three Gram negative organisms namely E Coli (11 , 10.2% , Pseudomonas (10 , 9.2% and Klebsiella (8 , 7.2%. No growth was obtained in 7(6.5% and other organisms were isolated in 7(6.5% specimens. Staphylococcus aureus was sensitive to vancomycin , clindamycin , cefoxitin , azithromycin and cotrimoxazole. Streptococcus pneumoniae was found to be sensitive to vancomycin , clindamycin , gentamicin , azithromycin , penicillin , cotrimoxazole , amoxicillin +clavulanic acid. Klebsiella was found to be sensitive to imipenem , azithromycin , ciprofloxacin , gentamicin and amoxicillin +clavulanic acid. E coli was sensitive to imipenem , gentamicin and amoxicillin +clavulanic acid. Pseudomonas aeruginosa was found to be sensitive to gentamicin , cefta zidime , imipenem , ticarcillin and piperacillin. CONCLUSION: Staphylococcus aureus and Streptococcus pneumoniae are the commonest organism causing pneumonia. Streptococcus pneumoniae is resistant to many antibiotics. Azithromycin can be the first line therapy for pneumonia.

  15. Sensitization to apomorphine in pigeons : unaffected by latent inhibition but still due to classical conditioning

    OpenAIRE

    Wynne, Brigitte; Delius, Juan

    1995-01-01

    When administered apomorphine, pigeons exhibit protracted bouts of pecking behavior. This response is subject to sensitization, as it initially increases with repeated drug injections. The hypothesis is examined that the sensitization is due to a Pavlovian conditioning of the drug-induced pecking to the environment in which it first takes effect. In a first experiment, we attempted to suppress this conditioning by extensively pre-exposing the birds to the test environment and saline injection...

  16. [Parental Care and Testosterone Secretion in Forest Rodent Males: Sensitization and Androgenic Stimulation of Parental Behavior].

    Science.gov (United States)

    Gromov, V S; Osadchuk, L V

    2015-01-01

    The reaction of males of three forest rodent species (Myodes clethrionomys, M. rutilus, Apodemus uralensis) to young animals in comparison with their dimensional characteristics and androgenization level was studied. Demonstration of parental care was detected in males of two vole species (M. clethrionomys and M. rutilus) in case of regular contacts with them (sensitization effect). It was demonstrated that the testosterone concentration in the blood serum, as well as the testosterone content in the testicles of the M. clethrionomys males (demonstrating the parental care), was higher than in the sample of males inclined to infanticide. An increased testosterone content in the testicles and blood serum was also found in the M. rutilus males that had contact with young animas. Neither demonstration of parental care nor significant differences in the testosterone concentration in the testicles and blood serum were detected in the A. uralensis males. PMID:26415283

  17. The Sensitiveness and Fulfillment of Psychological Needs: Medical, Health Care and Students.

    Science.gov (United States)

    Rakovec-Felser, Zlatka

    2015-09-01

    As health was defined as a state of complete physical, mental, and social well-being, and not merely an absence of disease or infirmity, the bio-psychosocial paradigm of health and illness attests that curing occurs when the science of medicine (the biomedical and pathos-physiological aspects of disease) and the art of medicine (the psychological, social, and interpersonal aspects of illness) merge into one unified holistic approach to patient care (Hojat, 2007). In this context the relationship between health care professionals and patients also become an indispensable tool in clinical situations to achieve better patient outcomes (Engel, 1990). In our pilot study in year 2009 we try to verify how are the medical students and students of health care (University of Maribor, Faculty of Medicine and Faculty of Health Care) prepared for their sensitive professional relationship in their future. Testing together 211 students (N=157 women, N=57 men), we compared the level of emotional empathy, altruistic love, values, and behaviorof 40 medical students, 118 students of health care and the group of 53 students of economics. Because of their professional choice, we expected that the medical and health care students would have higher empathy and altruism scores than the students of economics. Following the self-determination behavioral theory and its concept of autonomy support (Deci, Ryan, 2000), we anticipated also that the fulfilment of basic psychological needs could be important factor in everyday health care clinical practice. As the fulfilment of needs of autonomy, competence and relatedness could lead to increased autonomy supportive orientation in interactions with other subjects, and can be useful factor that prepare doctors or nurses for active participation in relationship with patients, we verified and compared the included groups also in this way. PMID:26898048

  18. Dutch care innovation units in elderly care: A qualitative study into students' perspectives and workplace conditions for learning.

    Science.gov (United States)

    Snoeren, Miranda; Volbeda, Patricia; Niessen, Theo J H; Abma, Tineke A

    2016-03-01

    To promote workplace learning for staff as well as students, a partnership was formed between a residential care organisation for older people and several nursing faculties in the Netherlands. This partnership took the form of two care innovation units; wards where qualified staff, students and nurse teachers collaborate to integrate care, education, innovation and research. In this article, the care innovation units as learning environments are studied from a student perspective to deepen understandings concerning the conditions that facilitate learning. A secondary analysis of focus groups, held with 216 nursing students over a period of five years, revealed that students are satisfied about the units' learning potential, which is formed by various inter-related and self-reinforcing affordances: co-constructive learning and working, challenging situations and activities, being given responsibility and independence, and supportive and recognisable learning structures. Time constraints had a negative impact on the units' learning potential. It is concluded that the learning potential of the care innovation units was enhanced by realising certain conditions, like learning structures and activities. The learning potential was also influenced, however, by the non-controllable and dynamic interaction of various elements within the context. Suggestions for practice and further research are offered. PMID:26694313

  19. The conditions for state action in Florida's health-care market.

    Science.gov (United States)

    Harkreader, S; Imershein, A W

    1999-06-01

    Despite the lack of confidence in government agencies to operate a nationalized health-care system in the United States, government agencies have significantly influenced the distribution and financing of health-care services in the market. Using the State of Florida as a case study, we examine the conditions under which a state health-care agency can consistently influence health-care market arrangements. We examined records from Florida's legislative sessions between 1965 and 1993 focusing on 27 legislative initiatives to involve the state's health-care agencies in the health-care services market. Using Boolean qualitative comparative analysis (QCA), we examined the conditions that facilitated or inhibited legislative policy initiatives for state action in Florida's health-care services market. The cohesiveness of state administrative agency and legislative leadership is of primary importance. Fragmented interests among health-care providers and fiscally legitimate policy positions, whether those of state agencies or health-care providers, are important enabling factors for state action. PMID:10467762

  20. Intercultural communication between patients and health care providers: an exploration of intercultural communication effectiveness, cultural sensitivity, stress, and anxiety.

    Science.gov (United States)

    Ulrey, K L; Amason, P

    2001-01-01

    Cultural diversity is becoming increasingly more important in the workplace. This is particularly true in health care organizations facing demographic shifts in the patients served and their families. This study serves to aid the development of intercultural communication training programs for health care providers by examining how cultural sensitivity and effective intercultural communication, besides helping patients, personally benefit health care providers by reducing their stress. Effective intercultural communication and cultural sensitivity were found to be related. Health care providers' levels of intercultural anxiety also were found to correlate with effective intercultural communication. PMID:11771806

  1. Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping

    Directory of Open Access Journals (Sweden)

    Tara Sampalli

    2015-07-01

    Full Text Available Background Recognizing the significant impact of wait times for care for individuals with complex chronic conditions, we applied a LEAN methodology, namely – an adaptation of Value Stream Mapping (VSM to meet the needs of people with multiple chronic conditions and to improve wait times without additional resources or funding. Methods Over an 18-month time period, staff applied a patient-centric approach that included LEAN methodology of VSM to improve wait times to care. Our framework of evaluation was grounded in the needs and perspectives of patients and individuals waiting to receive care. Patient centric views were obtained through surveys such as Patient Assessment of Chronic Illness Care (PACIC and process engineering based questions. In addition, LEAN methodology, VSM was added to identify non-value added processes contributing to wait times. Results The care team successfully reduced wait times to 2 months in 2014 with no wait times for care anticipated in 2015. Increased patient engagement and satisfaction are also outcomes of this innovative initiative. In addition, successful transformations and implementation have resulted in resource efficiencies without increase in costs. Patients have shown significant improvements in functional health following Integrated Chronic Care Service (ICCS intervention. The methodology will be applied to other chronic disease management areas in Capital Health and the province. Conclusion Wait times to care in the management of multimoribidities and other complex conditions can add a significant burden not only on the affected individuals but also on the healthcare system. In this study, a novel and modified LEAN methodology has been applied to embed the voice of the patient in care delivery processes and to reduce wait times to care in the management of complex chronic conditions.

  2. Sensitivity and specificity of point-of-care rapid combination syphilis-HIV-HCV tests.

    Directory of Open Access Journals (Sweden)

    Kristen L Hess

    Full Text Available New rapid point-of-care (POC tests are being developed that would offer the opportunity to increase screening and treatment of several infections, including syphilis. This study evaluated three of these new rapid POC tests at a site in Southern California.Participants were recruited from a testing center in Long Beach, California. A whole blood specimen was used to evaluate the performance of the Dual Path Platform (DPP Syphilis Screen & Confirm, DPP HIV-Syphilis, and DPP HIV-HCV-Syphilis rapid tests. The gold-standard comparisons were Treponema pallidum passive particle agglutination (TPPA, rapid plasma reagin (RPR, HCV enzyme immunoassay (EIA, and HIV-1/2 EIA.A total of 948 whole blood specimens were analyzed in this study. The sensitivity of the HIV tests ranged from 95.7-100% and the specificity was 99.7-100%. The sensitivity and specificity of the HCV test were 91.8% and 99.3%, respectively. The treponemal-test sensitivity when compared to TPPA ranged from 44.0-52.7% and specificity was 98.7-99.6%. The non-treponemal test sensitivity and specificity when compared to RPR was 47.8% and 98.9%, respectively. The sensitivity of the Screen & Confirm test improved to 90.0% when cases who were both treponemal and nontreponemal positive were compared to TPPA+/RPR ≥ 1 ∶ 8.The HIV and HCV on the multi-infection tests showed good performance, but the treponemal and nontreponemal tests had low sensitivity. These results could be due to a low prevalence of active syphilis in the sample population because the sensitivity improved when the gold standard was limited to those more likely to be active cases. Further evaluation of the new syphilis POC tests is required before implementation into testing programs.

  3. Is there a risk of sensitization and allergy to chlorhexidine in health care workers?

    DEFF Research Database (Denmark)

    Garvey, L H; Roed-Petersen, J; Husum, B

    2003-01-01

    BACKGROUND: In Denmark, chlorhexidine is the standard disinfectant in most hospitals and health care workers are repeatedly exposed to it. The aim of this study was to establish whether there is a risk of sensitization and allergy to chlorhexidine from this type of exposure. METHODS: Two hundred...... and forty-eight doctors, nurses and auxiliary staff were invited to participate in the study. One hundred and four individuals took part in the full study including skin tests and a questionnaire and a further 74 individuals filled in the questionnaire giving a total of 178 questionnaires (72%). Patch tests...... to examine the risk of type I and type IV allergy to chlorhexidine in health care workers with daily exposure to chlorhexidine, we did not identify allergies to chlorhexidine in any of the 104 individuals tested or in the additional 74 individuals who completed the questionnaire. We conclude that an allergy...

  4. Clusterin and chemotherapy sensitivity under normoxic and graded hypoxic conditions in colorectal cancer.

    LENUS (Irish Health Repository)

    Kevans, David

    2012-06-01

    In vitro studies have shown that clusterin modulates treatment sensitivity in a number of human cancers; however, the interaction between clusterin expression and hypoxia in controlling treatment response in CRC has not previously been examined. The aim of this study was to assess the effect of clusterin overexpression in CRC cells on sensitivity to 5-fluorouracil (5-FU), oxaliplatin and FOLFOX treatment under normoxic and graded hypoxic conditions.

  5. Premiums for Long-Term Care Insurance Packages: Sensitivity with Respect to Biometric Assumptions

    Directory of Open Access Journals (Sweden)

    Ermanno Pitacco

    2016-02-01

    Full Text Available Long-term care insurance (LTCI covers are rather recent products, in the framework of health insurance. It follows that specific biometric data are scanty; pricing and reserving problems then arise because of difficulties in the choice of appropriate technical bases. Different benefit structures imply different sensitivity degrees with respect to changes in biometric assumptions. Hence, an accurate sensitivity analysis can help in designing LTCI products and, in particular, in comparing stand-alone products to combined products, i.e., packages including LTCI benefits and other lifetime-related benefits. Numerical examples show, in particular, that the stand-alone cover is much riskier than all of the LTCI combined products that we have considered. As a consequence, the LTCI stand-alone cover is a highly “absorbing” product as regards capital requirements for solvency purposes.

  6. Antibiotic Sensitivity Pattern of Blood Isolates of Acinetobacter Species in a Tertiary Care Hospital: A Retrospective Analysis

    OpenAIRE

    P. S. Shareek; Sureshkumar, D; Ramgopalakrishnan; Ramasubramanian, V.; K. A. Ghafur; M. A. Thirunarayanan

    2012-01-01

    Problem statement: Multi-drug resistant Acinetobacter bacterium is one of the major causes of sepsis in ICUs in tertiary care hospitals in India. In this report we describe the antibiotic sensitivity patterns of Acinetobacter species isolated from blood over a one year period at a tertiary care hospital. Approach: We retrospectively analyzed the sensitivity pattern of Acinetobacter species isolated from blood during the period 1/6/2010 to 31/5/2011. Isolation and identification were performed...

  7. Occupational care giving conditions and human rights: A study of elderly caregivers in Botswana

    Directory of Open Access Journals (Sweden)

    Simon Kangethe

    2010-01-01

    Full Text Available The article aims to explore and discuss the occupational care giving conditions pitting them against human rights. The article′s objective is to initiate discussions and generate literature pertaining to occupational care giving load and assessing the human rights challenge it poses. The article uses analysis of the literature review from an array of eclectic data sources. The following factors were found besetting the caregivers′ human rights: (1 Aging; (2 Cultural and community attitudes towards care giving; (3 Risk of contagion; (4 Health hazards and lack of compensation. Recommendations: (1 Adoption of grandparents/grandchildren care symbiosis system; (2 Government remuneration policy for caregivers; (3 Mainstreaming of gender education to encourage men and youth develop an interest in care giving; (4 Institution of laws and policies by countries to provide for the compensation of caregivers′ occupational hazards and risks.

  8. Validation of the Danish version of the Patient Assessment of Care for Chronic Conditions questionnaire (PACIC)

    DEFF Research Database (Denmark)

    Sokolowski, Ineta; Maindal, Helle Terkildsen; Vedsted, Peter

    Objective: To evaluate the level of chronic care patients must be involved. The Danish version of the 20-item Patient Assessment of Care for Chronic Conditions PACIC questionnaire consisting of 5 scales and an overall summary score measuring patient reported assessment of structured chronic care...... has not been evaluated with regard to psychometric properties. This study aims to assess data quality and internal consistency and to validate the proposed factorial structure. Materials and methods: Setting: Diabetes population receiving chronic care in Denmark. Subjects: A total of 624 patients aged...... same questionnaire is constructed and applied to different countries with diverse cultural backgrounds and health care systems. It is decisive, that translated questionnaires are validated in country they are used....

  9. Relationship between continuity of care and adverse outcomes varies by number of chronic conditions among older adults with diabetes

    OpenAIRE

    DuGoff, Eva H.; Bandeen-Roche, Karen; Anderson, Gerard F.

    2016-01-01

    Background: Continuity of care is a basic tenant of primary care practice. However, the evidence on the importance of continuity of care for older adults with complex conditions is mixed. Objective: To assess the relationship between measurement of continuity of care, number of chronic conditions, and health outcomes. Design: We analyzed data from a cohort of 1,600 US older adults with diabetes and ≥1 other chronic condition in a private Medicare health plan from July 2010 to December 2011. M...

  10. What makes primary care effective for people in poverty living with multiple chronic conditions?: study protocol

    Directory of Open Access Journals (Sweden)

    Barbeau David

    2010-11-01

    Full Text Available Abstract Background The inverse care law persists: people living in poverty have the greatest needs and face considerable challenges in getting the care they need. Evidence reveals that GPs encounter difficulties in delivering care to poor patients, while many of those patients feel stigmatized by healthcare professionals. Patients living in poverty report negative healthcare experiences and unmet healthcare needs. Indeed, there is a growing recognition in primary care research of the importance of addressing the capabilities and social conditions of the poor when delivering care. Few studies have looked at the factors contributing to effective and "socially responsive" care for people living in poverty. Methods/Design Our study adopts a qualitative ethnographic approach in four healthcare organizations in deprived areas of metropolitan Montreal (Québec, Canada, using patient shadowing techniques and interviews. Data will be collected through fieldwork observations and informal interviews with patients before and after consultations. We will observe medical consultations, care organization activities, and waiting areas and reception of patients. We will conduct a total of 36 individual interviews with 12 GPs and 24 patients. The interviews will be audio-recorded and transcribed for purposes of analysis. The analysis consists of debriefing sessions, coding and interpretive analysis. Discussion This study aims to investigate how positive healthcare interactions between physicians and patients can improve the management of chronic conditions. We hypothesize that factors related to care organization, to healthcare professionals' experience and to patients may enhance the quality of healthcare interactions, which may have positive impacts for preventing and managing chronic conditions. Our study will provide a unique set of data grounded in the perspectives of healthcare professionals and of patients living in poverty.

  11. Fear conditioning fragments REM sleep in stress-sensitive Wistar-Kyoto, but not Wistar, rats

    OpenAIRE

    DaSilva, Jamie K.; Lei, Yanlin; Madan, Vibha; Mann, Graziella L.; Richard J. Ross; Tejani-Butt, Shanaz; Morrison, Adrian R.

    2010-01-01

    Pavlovian conditioning is commonly used to investigate the mechanisms of fear learning. Because the Wistar-Kyoto (WKY) rat strain is particularly stress-sensitive, we investigated the effects of a psychological stressor on sleep in WKY compared to Wistar (WIS) rats. Male WKY and WIS rats were either fear-conditioned to tone cues or received electric foot shocks alone. In the fear-conditioning procedure, animals were exposed to 10 tones (800 Hz, 90 dB, 5 sec), each co-terminating with a foot s...

  12. Assisting the Adult with a Respiratory Condition: Pharmacology. Care of the Adult.

    Science.gov (United States)

    Anoka-Hennepin Area Vocational Technical Inst., MN.

    These two units for students in a practical nursing program provide supplemental instruction, with a focus on pharmacology, in caring for adult patients with a respiratory condition. Unit titles are Antibiotics, and Drugs that Affect the Respiratory System. Each unit contains the following: objectives, an introduction, and five to nine learning…

  13. 42 CFR 418.110 - Condition of participation: Hospices that provide inpatient care directly.

    Science.gov (United States)

    2010-10-01

    ... patients have the right to be free from physical or mental abuse, and corporal punishment. All patients..., DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICARE PROGRAM HOSPICE CARE Conditions of participation... U.S.C. 552(a) and 1 CFR part 51. A copy of the code is available for inspection at the...

  14. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital, Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum Radji; Siti Fauziah; Nurgani Aribinuko

    2011-01-01

    Objective: To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit (ICU) of a tertiary care of Fatmawati Hospital Jakarta Indonesia. Methods: A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods, and their antibiotic susceptibility testing was performed using disk diffusion method. Results: Specimens were collected from 385 patients who were given antimicrobial treatment, of which 249 (64.68%) were cultured positive and 136 (35.32%) were negative. The most predominant isolate was Pseudomonas aeruginosa (P. aeruginosa) (26.5%) followed by Klebsiella pneumoniae (K. pneumoniae) (15.3%) and Staphylococcus epidermidis (14.9%). P. aeruginosa isolates showed high rate of resistance to cephalexin (95.3%), cefotaxime (64.1%), and ceftriaxone (60.9%). Amikacin was the most effective (84.4%) antibiotic against P. aeruginosa followed by imipenem (81.2%), and meropenem (75.0%). K. pneumoniae showed resistance to cephalexin (86.5%), ceftriaxone (75.7%), ceftazidime (73.0%), cefpirome (73.0%) and cefotaxime (67.9%), respectively. Conclusions: Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins, and quinolone antibiotics. Regular surveillance of antibiotic susceptibility patterns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  15. Improving the care of people with long-term conditions in primary care: protocol for the ENHANCE pilot trial

    Directory of Open Access Journals (Sweden)

    Emma L. Healey

    2015-12-01

    Full Text Available Background: Long-term conditions (LTCs are important determinants of quality of life and healthcare expenditure worldwide. Whilst multimorbidity is increasingly the norm in primary care, clinical guidelines and the delivery of care remain focused on single diseases, resulting in poorer clinical outcomes. Osteoarthritis, and anxiety and/or depression frequently co-occur with other LTCs, yet are seldom prioritized by the patient or clinician, resulting in higher levels of disability, poorer prognosis, and increased healthcare costs. Objective: To examine the feasibility and acceptability of an integrated approach to LTC management, tackling the under-diagnosis and under-management of osteoarthritis-related pain and anxiety and/or depression in older adults with other LTCs in primary care. Design: The ENHANCE study is a pilot stepped-wedge cluster randomized controlled trial to test the feasibility and acceptability of a nurse-led ENHANCE LTC review consultation for identifying, assessing, and managing joint pain, and anxiety and/or depression in patients attending LTC reviews. Specific objectives (process evaluation and research outcomes will be achieved through a theoretically informed mixed-methods approach using participant self-reported questionnaires, a medical record review, an ENHANCE EMIS template, qualitative interviews, and audio recordings of the ENHANCE LTC review. Discussion: Success of the pilot trial will be measured against the level of the primary care team engagement, assessment of training delivery, and degree of patient recruitment and retention. Patient satisfaction and treatment fidelity will also be explored. ISRCTN registry number: 12154418. Journal of Comorbidity 2015;5(1:135–149

  16. Conditioned frequency-dependent hearing sensitivity reduction in the bottlenose dolphin (Tursiops truncatus).

    Science.gov (United States)

    Nachtigall, Paul E; Supin, Alexander Ya

    2015-04-01

    The frequency specificity of conditioned dampening of hearing, when a loud sound is preceded by a warning sound, was investigated in a bottlenose dolphin. The loud sounds were 5 s tones of 16, 22.5 or 32 kHz, sound pressure level of 165 dB root mean square (RMS) re. 1 µPa. Hearing sensitivity was tested at the same three frequencies. Hearing sensitivity was measured using pip-train test stimuli and auditory evoked potential recording. The test sound stimuli served also as warning sounds. The durations of the warning sounds were varied randomly to avoid locking a conditioning effect to the timing immediately before the loud sound. Hearing thresholds before the loud sound increased, relative to the baseline, at test frequencies equal to or higher than the loud sound frequency. The highest threshold increase appeared at test frequencies of 0.5 octaves above the loud sound frequencies. PMID:25657210

  17. Differential effects of propranolol on conditioned hyperactivity and locomotor sensitization induced by morphine in rats

    OpenAIRE

    Shuguang Wei; Xinwang Li

    2014-01-01

    According to memory reconsolidation theory, when long-term memory is reactivated by relevant clues, the memory traces become labile, which can be altered by pharmacological manipulations. Accumulating evidence reveals that memory related to drug abuse can be erased by disrupting reconsolidation process. We used an animal model that could simultaneously measure conditioned hyperactivity and locomotor sensitization induced by morphine. β-adrenoceptor antagonist propranolol or saline were admini...

  18. Comparison of winter wheat yield sensitivity to climate variables under irrigated and rain-fed conditions

    Science.gov (United States)

    Xiao, Dengpan; Shen, Yanjun; Zhang, He; Moiwo, Juana P.; Qi, Yongqing; Wang, Rende; Pei, Hongwei; Zhang, Yucui; Shen, Huitao

    2015-11-01

    Crop simulation models provide alternative, less time-consuming, and cost-effective means of determining the sensitivity of crop yield to climate change. In this study, two dynamic mechanistic models, CERES (Crop Environment Resource Synthesis) and APSIM (Agricultural Production Systems Simulator), were used to simulate the yield of wheat (Triticum aestivum L.) under well irrigated (CFG) and rain-fed (YY) conditions in relation to different climate variables in the North China Plain (NCP). The study tested winter wheat yield sensitivity to different levels of temperature, radiation, precipitation, and atmospheric carbon dioxide (CO2) concentration under CFG and YY conditions at Luancheng Agro-ecosystem Experimental Stations in the NCP. The results from the CERES and APSIM wheat crop models were largely consistent and suggested that changes in climate variables influenced wheat grain yield in the NCP. There was also significant variation in the sensitivity of winter wheat yield to climate variables under different water (CFG and YY) conditions. While a temperature increase of 2°C was the threshold beyond which temperature negatively influenced wheat yield under CFG, a temperature rise exceeding 1°C decreased winter wheat grain yield under YY. A decrease in solar radiation decreased wheat grain yield under both CFG and YY conditions. Although the sensitivity of winter wheat yield to precipitation was small under the CFG, yield decreased significantly with decreasing precipitation under the rainfed YY treatment. The results also suggest that wheat yield under CFG linearly increased by ≈3.5% per 60 ppm (parts per million) increase in CO2 concentration from 380 to 560 ppm, and yield under YY increased linearly by ≈7.0% for the same increase in CO2 concentration.

  19. Comparison of winter wheat yield sensitivity to climate variables under irrigated and rain-fed conditions

    Science.gov (United States)

    Xiao, Dengpan; Shen, Yanjun; Zhang, He; Moiwo, Juana P.; Qi, Yongqing; Wang, Rende; Pei, Hongwei; Zhang, Yucui; Shen, Huitao

    2016-09-01

    Crop simulation models provide alternative, less time-consuming, and cost-effective means of determining the sensitivity of crop yield to climate change. In this study, two dynamic mechanistic models, CERES (Crop Environment Resource Synthesis) and APSIM (Agricultural Production Systems Simulator), were used to simulate the yield of wheat ( Triticum aestivum L.) under well irrigated (CFG) and rain-fed (YY) conditions in relation to different climate variables in the North China Plain (NCP). The study tested winter wheat yield sensitivity to different levels of temperature, radiation, precipitation, and atmospheric carbon dioxide (CO2) concentration under CFG and YY conditions at Luancheng Agro-ecosystem Experimental Stations in the NCP. The results from the CERES and APSIM wheat crop models were largely consistent and suggested that changes in climate variables influenced wheat grain yield in the NCP. There was also significant variation in the sensitivity of winter wheat yield to climate variables under different water (CFG and YY) conditions. While a temperature increase of 2°C was the threshold beyond which temperature negatively influenced wheat yield under CFG, a temperature rise exceeding 1°C decreased winter wheat grain yield under YY. A decrease in solar radiation decreased wheat grain yield under both CFG and YY conditions. Although the sensitivity of winter wheat yield to precipitation was small under the CFG, yield decreased significantly with decreasing precipitation under the rainfed YY treatment. The results also suggest that wheat yield under CFG linearly increased by ≈3.5% per 60 ppm (parts per million) increase in CO2 concentration from 380 to 560 ppm, and yield under YY increased linearly by ≈7.0% for the same increase in CO2 concentration.

  20. Using operant conditioning and desensitization to facilitate veterinary care with captive reptiles.

    Science.gov (United States)

    Hellmuth, Heidi; Augustine, Lauren; Watkins, Barbara; Hope, Katharine

    2012-09-01

    In addition to being a large component of most zoological collections, reptile species are becoming more popular as family pets. Reptiles have the cognitive ability to be trained to facilitate daily husbandry and veterinary care. Desensitization and operant conditioning can alleviate some of the behavioral and physiological challenges of treating these species. A survey of reptile training programs at zoos in the United States and worldwide reveals that there are many successful training programs to facilitate veterinary care and minimize stress to the animal. Many of the techniques being used to train reptiles in zoological settings are transferable to the exotic pet clinician. PMID:22998960

  1. Thermo-mechanical sensitivity analysis of repository design parameters using Korean geological conditions

    International Nuclear Information System (INIS)

    Extensive sensitivity analysis had been carried out for the seven design parameters, which can influence on the thermal-mechanical coupling behavior because of the stress in deep underground as well as the heat from the high-level radioactive waste. In this study, the three-dimensional commercial code, FLAC3D, was used for analyzing the sensitivity of the design parameters, which are related to disposal tunnel and deposition hole, on the temperature, stress, and displacement. The geological data measured at the two drilling sites, Yusung and Kosung, were used in the modelings. From the modelings, it was possible to investigate the thermal-mechanical coupling behavior of the deep underground repository under Korean geological conditions. Fractional factorial design was utilized for effective experimental design for the sensitivity analysis. Different techniques of sensitivity analysis were applied for the modeling results. From the analysis, it was possible to conclude that the deposition hole spacing is the most important parameter on the thermal-mechanical coupling behavior

  2. Paternal care decreases foraging activity and body condition, but does not impose survival costs to caring males in a Neotropical arachnid.

    Directory of Open Access Journals (Sweden)

    Gustavo S Requena

    Full Text Available Exclusive paternal care is the rarest form of parental investment in nature and theory predicts that the maintenance of this behavior depends on the balance between costs and benefits to males. Our goal was to assess costs of paternal care in the harvestman Iporangaia pustulosa, for which the benefits of this behavior in terms of egg survival have already been demonstrated. We evaluated energetic costs and mortality risks associated to paternal egg-guarding in the field. We quantified foraging activity of males and estimated how their body condition is influenced by the duration of the caring period. Additionally, we conducted a one-year capture-mark-recapture study and estimated apparent survival probabilities of caring and non-caring males to assess potential survival costs of paternal care. Our results indicate that caring males forage less frequently than non-caring individuals (males and females and that their body condition deteriorates over the course of the caring period. Thus, males willing to guard eggs may provide to females a fitness-enhancing gift of cost-free care of their offspring. Caring males, however, did not show lower survival probabilities when compared to both non-caring males and females. Reduction in mortality risks as a result of remaining stationary, combined with the benefits of improving egg survival, may have played an important and previously unsuspected role favoring the evolution of paternal care. Moreover, males exhibiting paternal care could also provide an honest signal of their quality as offspring defenders, and thus female preference for caring males could be responsible for maintaining the trait.

  3. Antibiotic sensitivity pattern of bacterial pathogens in the intensive care unit of Fatmawati Hospital,Indonesia

    Institute of Scientific and Technical Information of China (English)

    Maksum; Radji; Siti; Fauziah; Nurgani; Aribinuko

    2011-01-01

    Objective:To evaluate the sensitivity pattern of bacterial pathogens in the intensive care unit(ICU) of a tertiary care of Falmawati Hospital Jakarta Indonesia.Methods:A cross sectional retrospective study of bacterial pathogen was carried out on a total of 722 patients that were admitted to the ICU of Fatmawati Hospital Jakarta Indonesia during January 2009 to March 2010. All bacteria were identified by standard microbiologic methods,and(heir antibiotic susceptibility testing was performed using disk diffusion method.Results:Specimens were collected from 385 patients who were given antimicrobial treatment,of which 249(64.68%) were cultured positive and 136(35.32%) were negative.The most predominant isolate was Pseudomonas aeruginosa(P.aeruginosa)(26.5%) followed by Klebsiella pneumoniae(K.pneumoniae)(15.3%) and Staphylococcus epidermidis(14.9%).P.aeruginosa isolates showed high rate of resistance to cephalexin(95.3%),cefotaxime(64.1%),and ceftriaxone(60.9%).Amikacin was the most effective(84.4%) antibiotic against P.aeruginosa followed by imipenem(81.2%),and meropenem(75.0%).K.pneumoniae showed resistance to cephalexin(86.5%),ceftriaxone(75.7%),ceftazidime(73.0%),cefpirome(73.0%) and cefotaxime(67.9%),respectively.Conclusions:Most bacteria isolated from ICU of Fatmawati Hospital Jakarta Indonesia were resistant to the third generation of cephalosporins,and quinolone antibiotics.Regular surveillance of antibiotic susceptibility pallerns is very important for setting orders to guide the clinician in choosing empirical or directed therapy of infected patients.

  4. Role of cage material, working style and hearing sensitivity in perception of animal care noise.

    Science.gov (United States)

    Voipio, H-M; Nevalainen, T; Halonen, P; Hakumäki, M; Björk, E

    2006-10-01

    During daily care, laboratory animals are exposed to a variety of sounds which may have effects on welfare and also cause physiological and behavioural changes. So far, almost no attention has been paid to individual sounds or the sound level caused by animal care or the sound level inside the animal cage. In this study, sounds from selected rat care procedures were recorded: pulling cage out of the rack, placing it onto a table and replacing the cage back into the rack; with measurements made inside the rat cage and in the adjacent cage. Diet was poured into the food hopper and sounds were recorded inside the cage and also the adjacent cage. The work was repeated in a calm and also in a hurried style, using stainless steel and polycarbonate cages. Finally, the sounds produced by running tap water were recorded. Differences between rat and human hearing were compared using novel species-specific sound level weightings: R-weighting for rats dB(R) and H-weighting for human dB(H). Hurried work with steel caused sound exposure levels exceeding 90 dB(R) when the cages were placed into the rack and about 80 dB(R) when pulling them out of the rack or placing onto a table. With polycarbonate, the levels were 10-15 dB(R) lower. Unhurried calm working produced lower sound exposure levels than hurried working in many procedures. When the procedures were repeated with measurements in the adjacent cage, the sound exposure levels were lower, but the results were similar. Pouring food pellets into a hopper above the rat's head caused 15 dB(R) higher sound exposure levels than pouring food to an adjacent cage. In general, humans hear these sounds about 10-15 dB louder than rats. In conclusion, cage material, working style and hearing sensitivity all have an impact on the sound exposure level in the rodent cage. With correct working methods, high sound levels can be efficiently avoided in most cases. PMID:17018211

  5. Body condition and physical care scales in three cases of dog hoarding from Belgrade

    Directory of Open Access Journals (Sweden)

    Vučinić Marijana

    2007-01-01

    Full Text Available In the spring of 2006 Belgrade city officials were planning to take steps to reduce the city’s stray dog population. The plan was to sterilize (spay or neuter, microchip and vaccinate about 5000 dogs during the next two years. The plan was set to kick into action at the start of September in 2006, with a monthly goal of spaying or neutering at least 255 dogs. Taking the program one step further, approximately 15000 dog owners will be given free microchips for their dogs, among them owners of private dogs' shelters, too. A professional team of four members was formed with the aim to visit all private shelters for dogs in Belgrade. The team found three cases of dog hoarding. In all of them, hoarders claimed to possess a "no-kill" shelter for dogs. These hoarders were likely to exhibit characteristics between overwhelmed caregivers and rescuer hoarders. These cases of hoarding are described in this paper from the dog abuse aspect. The two parts of Tufts Animal Care and Condition (TACC scales were used for this purpose (body condition and physical care scales. Body condition and physical care were evaluated in 429 dogs (220 dogs in the first, 157 dogs in the second and 52 dogs in the third hoarder. There were significant differences (P<0.0001 only for body condition of dogs in three cases of hoarders. Inadequate diet was the main reason for this state. Physical care of dogs ranged from borderline to terrible without significant differences between three cases of animal hoarding.

  6. Is fumigation enough for air conditioning units in operation theatres and Intensive care units?

    OpenAIRE

    Anasua Deb; Sharmila Raut; Sunita Gajbhiye; Priyanka Patil; Sanjay Raut

    2016-01-01

    Background: Strict asepsis is necessary in operating theatres (OT) and intensive care units (ICU) as the patients undergo invasive procedures. The filters of contaminated air conditioning (AC) units provide a niche for proliferation of fungi and production of fungal spores. Methods: The routine procedure for maintenance of sterile atmosphere in our hospital, i.e. fumigation and mopping walls with disinfectants often fail to address these fungal spores of the AC filters. We therefore carri...

  7. Temperament, disordered attachment and parental sensitivity in foster care: Differential findings on attachment security for shy children

    NARCIS (Netherlands)

    Schipper, de J.C.; Oosterman, M.; Schuengel, C.

    2012-01-01

    In a foster care sample, we tested the moderating effect of temperamental shyness on the association between parental sensitivity and attachment quality. The foster parents of 59 foster children (age M = 57 months, SD = 16.4) filled out the Child Behavior Questionnaire. To control for confounds, sym

  8. Sensitivity of fuel rod behavior on as fabricated characteristics and on operating conditions

    International Nuclear Information System (INIS)

    BELGONUCLEAIRE's gradually increasing in-reactor experience has enabled the continuous development and assessment over the years of a coherent set of specifications and drawings for UO2-PuO2 and UO2 fuel for LWR's. On the basis of this experience, design codes have been developed, benchmarked and are thereafter applied to cover completely the whole range of fuel specifications and irradiation histories. The sensitivity of the fuel rod behavior on as fabricated characteristics and on operating conditions (steady and transient) is outlined through calculation results on the COMETHE III-J computer code

  9. Hidden caring, hidden carers? Exploring the experience of carers for people with long-term conditions.

    Science.gov (United States)

    Knowles, Sarah; Combs, Ryan; Kirk, Sue; Griffiths, May; Patel, Neesha; Sanders, Caroline

    2016-03-01

    Informal carers make a significant contribution to illness management in communities, but many struggle to access support and remain 'hidden carers'. We aimed to explore how carers of people with common long-term conditions (LTCs, such as coronary heart disease or kidney disease) conceptualised their caring, and whether they struggled to identify themselves with the term 'carer' or access for support. We conducted semi-structured interviews with 19 informal carers of people with LTCs recruited from local support groups. Topic guides were designed to encourage participants to provide their retrospective accounts of identifying as a carer or struggling to do so. Data were analysed using the constant comparative method. The study was designed collaboratively with a patient and public involvement (PPI) partner, and we consulted with a PPI steering group of people with lived experience of caring during the study. Results showed how participants drew on comparisons with those caring for more dependent relatives in explaining their reluctance to define themselves as a carer, and resisted adopting the label due to concerns that it would threaten the identity of the cared-for person. The data were interpreted in terms of types of 'work' undertaken to manage LTCs, and revealed that carers of patients with LTCs appear to primarily engage in biographical and emotional support, which may be more difficult to conceptualise as legitimate caring 'work'. Participants indicated that health professionals may be in a unique position to validate their role as carers and encourage support seeking. The study suggests how the greater focus on self-management of LTCs in the community must be complemented by recognition of this group as potentially 'hidden carers', who support the patient to minimise the impact the illness has on their lives and consequently may minimise their own caring role, with negative implications for support seeking. PMID:25706665

  10. Simultaneous effect of disabling conditions on primary health care use through a capability approach.

    Science.gov (United States)

    Bussière, Clémence; Sicsic, Jonathan; Pelletier-Fleury, Nathalie

    2016-04-01

    There is evidence of social disparities in the use of primary health services in most European countries, and these disparities particularly affect people with disabilities. Many determinants of disabilities interact to limit access to health care (e.g. impairments, functional limitations, educational level). However, these determinants have typically been examined separately. We adopted a capabilities perspective to define multidimensional disability. Capabilities refer to individuals' real opportunities to achieve possible outcomes. In this context, we aimed to assess disability through latent capabilities (shaped by personal, social and environmental variables) and to simultaneously analyze their effects on primary health care use (GP and nurse care; cervical, breast, and colorectal cancer screenings). We used a structural equation modeling framework, which allowed complete and simultaneous tests of relationships taking into account measurement errors. The data source was the 2008 French Health and Disability Survey (29,931 individuals). Potential disability-related determinants were selected to measure five latent variables: health condition and cognitive, physical, societal, and socioeconomic capabilities. All things being equal, we did not identify any specific barriers to GP care use. We found a lower likelihood of nursing care use among people with lower cognitive capabilities. Unlike usual findings, we did not observe a significant influence of either cognitive or physical capabilities for any type of cancer screening use. However, cancer screening participation was mainly affected by societal and socioeconomic capabilities. Considering the capability approach, which suggests public action oriented toward restoring capabilities of individuals, future programs should seek to increase societal support to compensate for disability. This approach could be helpful in reducing inequalities in health care access. PMID:26945545

  11. Model Forecast Skill and Sensitivity to Initial Conditions in the Seasonal Sea Ice Outlook

    Science.gov (United States)

    Blanchard-Wrigglesworth, E.; Cullather, R. I.; Wang, W.; Zhang, J.; Bitz, C. M.

    2015-01-01

    We explore the skill of predictions of September Arctic sea ice extent from dynamical models participating in the Sea Ice Outlook (SIO). Forecasts submitted in August, at roughly 2 month lead times, are skillful. However, skill is lower in forecasts submitted to SIO, which began in 2008, than in hindcasts (retrospective forecasts) of the last few decades. The multimodel mean SIO predictions offer slightly higher skill than the single-model SIO predictions, but neither beats a damped persistence forecast at longer than 2 month lead times. The models are largely unsuccessful at predicting each other, indicating a large difference in model physics and/or initial conditions. Motivated by this, we perform an initial condition sensitivity experiment with four SIO models, applying a fixed -1 m perturbation to the initial sea ice thickness. The significant range of the response among the models suggests that different model physics make a significant contribution to forecast uncertainty.

  12. A vegetation sensitivity approximation for gross primary production in water limited conditions.

    Science.gov (United States)

    Claesson, Jonas; Nycander, Jonas

    2013-04-01

    The most severe impact of climate change on vegetation growth and agriculture is likely to occur under water-limited conditions. Under such conditions the plants optimize the inward flux of CO2 and the outward flux of water vapor (the transpiration) by regulating the size of the stomata openings. Higher temperature increases water loss through transpiration, forcing the plants to diminish the stomata openings, which decreases photosynthesis. This is counteracted by higher CO2 concentration, which allows plants to maintain the inward flux of CO2 through the smaller openings. These two counteracting effects, combined with the change in precipitation, determine the net change of biological productivity in a changed climate. Here, a vegetation sensitivity approximation (VSA) is introduced, in order to understand and estimate the combined effect of changed temperature, CO2-concentration and precipitation on gross primary production (GPP) to first order. According to the VSA, we have: ( ) ?CO2atm ν GP P = ?0 P Here ?CO2atm is the atmospheric CO2 concentration, ?0 is the baseline for atmospheric CO2 concentration, P is precipitation and ν is defined by: -s- ν = 1 - 11°C where s is the climate sensitivity i.e. the increase in temperature when atmospheric CO2 is doubled. The VSA is based on the physical laws of gas flux through the stomata openings, and is only valid under water-limited conditions. It assumes that the temperature depends logarithmically on the CO2 concentration with a given climate sensitivity. Transpiration is assumed to be a constant fraction of precipitation, which is reasonable under water-limited conditions. The VSA is compared to simulations with the dynamic vegetation model LPJ. The agreement is reasonable, and the deviations can be understood by comparison with Köppen's definition of arid climate: in an arid climate growth increases more according to LPJ than according to the VSA, and in non-arid conditions the reverse is true. Both the VSA and

  13. Catchment Sensitivity to Changing Climate Conditions: The Importance of Landscape Characteristics

    Science.gov (United States)

    Teutschbein, Claudia; Karlsen, Reinert; Grabs, Thomas; Laudon, Hjalmar; Bishop, Kevin

    2015-04-01

    The scientific literature is full of studies analyzing future climate change impacts on hydrology with focus on individual catchments. We recently found, however, that hydrologic behavior and specific discharge vary considerably even in neighboring and rather similar catchments under current climate conditions and that these variations are related to landscape characteristics. Therefore we hypothesize that these landscape characteristics also play a fundamental role for the sensitivity of a catchment to changing climate conditions. We analyzed the hydrological response of 14 partially nested catchments in Northern Sweden with slightly different topography, land cover, size and geology. Current (1981-2010) and future (2061-2090) streamflows were simulated with the hydrological model HBV light based on 15 regional climate model projections that were bias-corrected with a distribution-mapping approach. Our simulations revealed that - in a future climate- the total annual streamflow will be higher, spring flood peaks will occur earlier and decrease considerably, whereas winter base flows will more than double. These changes are somewhat expected and mainly triggered by a projected increase in winter temperature, which leads to less snow accumulation on the ground. However, our results also show that there is a large variability amongst these catchments in their hydrological response to the same future climate conditions. We identified wetlands, lakes, peat soils and higher elevations as factors that had a stronger effect on spring floods, whereas catchments dominated by forests, steeper slopes and till soils showed stronger responses in winter base flows and total annual streamflow. Therefore, our results suggest that the sensitivity of catchments to future climate conditions is strongly linked to landscape characteristics and also depends on the streamflow characteristic as well as season analyzed.

  14. Catchment sensitivity to changing climate conditions: the importance of landscape characteristic

    Science.gov (United States)

    Teutschbein, C.; Karlsen, R.; Grabs, T.; Laudon, H.; Bishop, K. H.

    2014-12-01

    The scientific literature is full of studies analyzing future climate change impacts on hydrology with focus on individual catchments. However, we recently found that hydrologic behavior and specific discharge vary considerably even in neighboring and rather similar catchments under current climate conditions and that these variations are related to landscape characteristics. Therefore we hypothesize that these landscape characteristics also play a fundamental role for the sensitivity of a catchment to changing climate conditions. We analyzed the hydrological response of 14 neighboring catchments in Northern Sweden with slightly different topography, land cover, size and geology. Current (1981-2010) and future (2061-2090) streamflow was simulated with the HBV light model. Climate projections were based on 14 regional climate models (ENSEMBLES EU project) and bias-corrected with a distribution-mapping approach. Our simulations revealed that future spring flood peaks will occur much earlier and decrease by 13 to 32 %, whereas winter base flows will increase slightly. These changes are somewhat expected and mainly triggered by a projected increase in winter temperature, which leads to less snow accumulation on the ground. However, these values also highlight that there is a large variability amongst the catchments in their hydrological response to the same future climate conditions. For example, spring flood peaks in catchments without wetlands decrease by only 13 to 15 %, whereas catchments with wetlands show a spring flood peak reduction of 20 to 32 %. In addition to wetlands, we also identified lakes, peat soils and higher elevations as factors that seem to cause a stronger hydrological response to the climate change signal, whereas catchments dominated by forests, steeper slopes and till soils seem to be less strongly affected by a changing climate. Therefore, our results suggest that the sensitivity of catchments to future climate conditions is strongly linked to

  15. Brief encounters: what do primary care professionals contribute to peoples’ self-care support network for long-term conditions? A mixed methods study

    OpenAIRE

    Rogers, Anne; Vassilev, Ivaylo; Brooks, Helen; Kennedy, Anne; Blickem, Christian

    2016-01-01

    Background Primary care professionals are presumed to play a central role in delivering long-term condition management. However the value of their contribution relative to other sources of support in the life worlds of patients has been less acknowledged. Here we explore the value of primary care professionals in people’s personal communities of support for long-term condition management. Methods A mixed methods survey with nested qualitative study designed to identify relationships and socia...

  16. Mephedrone ('bath salt') elicits conditioned place preference and dopamine-sensitive motor activation.

    Science.gov (United States)

    Lisek, Renata; Xu, Wei; Yuvasheva, Ekaterina; Chiu, Yi-Ting; Reitz, Allen B; Liu-Chen, Lee-Yuan; Rawls, Scott M

    2012-11-01

    Abuse of a dangerous street drug called mephedrone (4-methylmethcathinone) has become commonplace in the United States. Mephedrone is hypothesized to possess abuse liability, share pharmacological properties with psychostimulants, and display toxicity that has been linked to fatalities and non-fatal overdoses. Knowledge about the pharmacology of mephedrone has been obtained primarily from surveys of drug abusers and emergency room visits rather than experimental studies. The present study used motor activity and conditioned place preference (CPP) assays to investigate behavioral effects of mephedrone. Acute mephedrone (3, 5, 10, 30 mg/kg, ip) administration increased ambulatory activity in rats. Mephedrone (5 mg/kg, ip)-induced ambulation was inhibited by pretreatment with a dopamine D1 receptor antagonist (SCH 23390) (0.5, 1, 2 mg/kg, ip) and enhanced by pretreatment with a dopamine D2 receptor antagonist (sulpiride) (2 mg/kg, ip). Rats injected for 5 days with low dose mephedrone (0.5 mg/kg, ip) and then challenged with mephedrone (0.5 mg/kg, ip) following 10 days of abstinence displayed sensitization of ambulatory activity. In CPP experiments, mephedrone (30 mg/kg, ip) conditioning elicited a preference shift in both rats and mice. The CPP and dopamine-sensitive motor activation produced by mephedrone is suggestive of abuse liability and indicates commonalities between the neuropharmacological profiles of mephedrone and established drugs of abuse. PMID:22652295

  17. Antibiotic Sensitivity Pattern of Blood Isolates of Acinetobacter Species in a Tertiary Care Hospital: A Retrospective Analysis

    Directory of Open Access Journals (Sweden)

    P. S. Shareek

    2012-01-01

    Full Text Available Problem statement: Multi-drug resistant Acinetobacter bacterium is one of the major causes of sepsis in ICUs in tertiary care hospitals in India. In this report we describe the antibiotic sensitivity patterns of Acinetobacter species isolated from blood over a one year period at a tertiary care hospital. Approach: We retrospectively analyzed the sensitivity pattern of Acinetobacter species isolated from blood during the period 1/6/2010 to 31/5/2011. Isolation and identification were performed using the best alert system and VITEK2 respectively. Sensitivities were determined by Kirby Bauer disc diffusion and broth dilution using VITEK2 -AST cards. Results: The total number of Acinetobacter species isolated during the study period was 72, out of which 57 (79% were A. baumanii, 7 (9.7% were A. Iwofii and 3 (5.2% were A. Junii. One each from A. calcoaceticus, A. ursingii and A. denitrificans were isolated. All of the baumanii isolates were sensitive to polymyxin B and 61.4% were sensitive to tigecycline. Only 25% of the isolates in baumanii group were sensitive to meropenem and imipenem. In the non-baumanii group however, 73% were sensitive to carbapenems. Conclusion: There is a very high incidence of resistance to most antibiotics, including carbapenems. All of the Acinetobacter isolates tested are sensitive to polymyxin B. Tigecycline is the only other drug with reasonable susceptibilities, but this drug is not recommended for primary bacteriemias. If Acinetobacter sepsis is suspected, empiric therapy with polymyxins, followed by de-escalation after sensitivity results are back, is advisable.

  18. A highly sensitive and simply operated protease sensor toward point-of-care testing.

    Science.gov (United States)

    Park, Seonhwa; Shin, Yu Mi; Seo, Jeongwook; Song, Ji-Joon; Yang, Haesik

    2016-04-21

    Protease sensors for point-of-care testing (POCT) require simple operation, a detection period of less than 20 minutes, and a detection limit of less than 1 ng mL(-1). However, it is difficult to meet these requirements with protease sensors that are based on proteolytic cleavage. This paper reports a highly reproducible protease sensor that allows the sensitive and simple electrochemical detection of the botulinum neurotoxin type E light chain (BoNT/E-LC), which is obtained using (i) low nonspecific adsorption, (ii) high signal-to-background ratio, and (iii) one-step solution treatment. The BoNT/E-LC detection is based on two-step proteolytic cleavage using BoNT/E-LC (endopeptidase) and l-leucine-aminopeptidase (LAP, exopeptidase). Indium-tin oxide (ITO) electrodes are modified partially with reduced graphene oxide (rGO) to increase their electrocatalytic activities. Avidin is then adsorbed on the electrodes to minimize the nonspecific adsorption of proteases. Low nonspecific adsorption allows a highly reproducible sensor response. Electrochemical-chemical (EC) redox cycling involving p-aminophenol (AP) and dithiothreitol (DTT) is performed to obtain a high signal-to-background ratio. After adding a C-terminally AP-labeled oligopeptide, DTT, and LAP simultaneously to a sample solution, no further treatment of the solution is necessary during detection. The detection limits of BoNT/E-LC in phosphate-buffered saline are 0.1 ng mL(-1) for an incubation period of 15 min and 5 fg mL(-1) for an incubation period of 4 h. The detection limit in commercial bottled water is 1 ng mL(-1) for an incubation period of 15 min. The developed sensor is selective to BoNT/E-LC among the four types of BoNTs tested. These results indicate that the protease sensor meets the requirements for POCT. PMID:26980003

  19. Assessing patient-centered care in patients with chronic health conditions attending chiropractic practice: protocol for a mixed-methods study

    OpenAIRE

    Stuber, Kent Jason; Langweiler, Mark; Mior, Silvano; McCarthy, Peter William

    2016-01-01

    Background The management of chronic health conditions increasingly requires an organized, coordinated, and patient-centered approach to care. The Chronic Care Model (CCM) has been adopted in primary care to improve care delivery for those with chronic health conditions. Chiropractors manage chronic health conditions; however, little is known if such care is patient-centered. The primary aim of this study is to determine to what extent chiropractic patients with chronic health conditions perc...

  20. Sensitivity to Speaker Control in the Online Comprehension of Conditional Tips and Promises: An Eye-Tracking Study

    Science.gov (United States)

    Stewart, Andrew J.; Haigh, Matthew; Ferguson, Heather J.

    2013-01-01

    Statements of the form if… then… can be used to communicate conditional speech acts such as tips and promises. Conditional promises require the speaker to have perceived control over the outcome event, whereas conditional tips do not. In an eye-tracking study, we examined whether readers are sensitive to information about perceived speaker control…

  1. Sensitivity of ICTP Regional Climate Model (RegCM3) to Initial and Lateral Boundary Conditions

    Science.gov (United States)

    Nadeem, I.; Formayer, H.

    2009-04-01

    Regional climate simulations require lateral boundary conditions. These are typically reanalysis of past observations or alternatively, output from climate general circulation models. Lateral boundary conditions are available at various temporal and spatial resolutions. At present, spatial resolution of reanalysis datasets ranges from few kilometers, for example, regional reanalysis limited to only single continent, to the coarser but global datasets like ECMWF 40 Years Re-Analysis. While these datasets represent reasonable analyses of 3-D atmospheric as well as surface conditions, their resolutions, the physics of the models used to generate them, and the means of assimilating data into them can produce very different results when used as boundary conditions for regional climate models. The sensitivity of ICTP Regional Climate Model (RegCM3) to different lateral boundary conditions was investigated over the Alpine region. The model was run directly at 10km horizontal resolution as well as in one-way double nested mode, with a 30 km grid point spacing mother domain encompassing the Europe and a 10 km grid point spacing nested domain covering the Alpine Region. The simulations spans the one-year period of 1989. The boundary conditions used for various simulations were ECMWF Interim Re-Analysis (ERA-Interim, 0.75° and 1.5° grid spacings, 6-h intervals), the ECMWF 40 Years Re-Analysis (ERA40, 1° and 2.5° grid spacings, 6-h interval) and finally the 2.5°, 6-h NCEP/DOE AMIP-II Reanalysis (Reanalysis-2). Sea Surface Temperature for the simulated periods were obtained from a UK Met Office Global Ocean Surface Temperature (GISST), a set of SST data in monthly 1° area grids. When recently released ERA-Interim Reanalysis, which is based on a recent release of the Integrated Forecasting System (IFS Cy31r2) containing many improvements both in the forecasting model and analysis methodology, was used as lateral and boundary conditions, the simulated precipitation field

  2. On conditions and parameters important to model sensitivity for unsaturated flow through layered, fractured tuff

    International Nuclear Information System (INIS)

    The Hydrologic Code Intercomparison Project (HYDROCOIN) was formed to evaluate hydrogeologic models and computer codes and their use in performance assessment for high-level radioactive-waste repositories. This report describes the results of a study for HYDROCOIN of model sensitivity for isothermal, unsaturated flow through layered, fractured tuffs. We investigated both the types of flow behavior that dominate the performance measures and the conditions and model parameters that control flow behavior. We also examined the effect of different conceptual models and modeling approaches on our understanding of system behavior. The analyses included single- and multiple-parameter variations about base cases in one-dimensional steady and transient flow and in two-dimensional steady flow. The flow behavior is complex even for the highly simplified and constrained system modeled here. The response of the performance measures is both nonlinear and nonmonotonic. System behavior is dominated by abrupt transitions from matrix to fracture flow and by lateral diversion of flow. The observed behaviors are strongly influenced by the imposed boundary conditions and model constraints. Applied flux plays a critical role in determining the flow type but interacts strongly with the composite-conductivity curves of individual hydrologic units and with the stratigraphy. One-dimensional modeling yields conservative estimates of distributions of groundwater travel time only under very limited conditions. This study demonstrates that it is wrong to equate the shortest possible water-travel path with the fastest path from the repository to the water table. 20 refs., 234 figs., 10 tabs

  3. Sensitivity analysis of upstream plasma condition for SST-1 X-divertor configuration with SOLPS

    International Nuclear Information System (INIS)

    The extensive power exhausts and target heat loads are anticipated in reactor grade fusion devices. Prototyping of an X-Divertor based power exhaust scheme is being attempted by means of simulations of Scrape-off Layer plasma transport in the diverted plasma equilibria of SST-1 tokamak using SOLPS5.1. Evaluation of the relative advantages of an X-Divertor configuration involves simulating the SST-1 standard divertor scheme plasma transport for the reference and then achieving equivalent upstream plasma conditions in the X-divertor equilibrium to ensure an equivalent core plasma in both the cases. The first optimization is to be achieved by simulating effects of an external gas puff in the SOL region for controlling separatrix density in the X-divertor configuration with visible modifications in the downstream plasma conditions. The present work analyzes sensitivity of the upstream SOL plasma conditions to the gas puff intensity and its effect on the plasma neutral transport in the divertor region. (author)

  4. [Requirements of optimal working conditions and patient-centered care in hospital nursing].

    Science.gov (United States)

    Walter, A; Merboth, H; Böger, S

    1997-12-01

    Nursing--a human service increasing in size and significance--is facing deep changes. The organization of hospital wards is also influenced by these profound changes. The aim of this psychological research project sponsored by the German Federal Ministry for Education and Science, Research and Technology (BMBF) and part of the Saxonian Public Health Association was to determine the external and individual working conditions that put the personnel's health at risk, particularly in regard to burnout syndromes. Investigations should show possibilities in work organization that minimize such risks. Organizational designs have to ensure high quality levels of nursing care, as well as high quality of working conditions in nursing for the individual employee. This empirical study presents the results of an investigation of 53 medical, surgical and intensive care units of 7 Saxonian hospitals with 336 employees of the nursing departments. The size of the hospital, the service profile, the nursing standards and the organizational conditions of the nursing service influence work pressure and working attitude. PMID:9456781

  5. Work and health conditions of nursing staff in palliative care and hospices in Germany

    Directory of Open Access Journals (Sweden)

    Schröder, Christina

    2004-11-01

    Full Text Available Aims of this representative study were to assess the relevant differences between the work and organisational characteristics as well as the subjective resources and health status of nurses occupied in hospice care, compared to nurses from palliative stations. Further, the assessment of the predictive correlations between the work situation of this nurses as a factor influencing their health and perceived strains was also a leading intention.Method: In a written survey conducted in Germany in 2001, 820 nursing staff of 113 palliative stations and stationary hospices were included. A qualified diagnostic procedure for the assessment of health promoting work was implemented. In order of obtaining a secure comparison, a sample of 320 nurses working in 12 homes for old people in Saxony was also considered.Results: The nurses referred generally to favourable working conditions, still they informed about deficiencies in the perceived participation, organizational benefits and experienced gratification. Hospice nurses experienced overall more favourable work conditions than palliative nurses or than the staff of homes for old people (regarding identification with the institution, organizational benefits, accurate gratification and little time pressure during work. Hospice personnel were psychologically and physically healthier than the staff of palliative stations. Important predictors for health stability that could be assessed by multiple regression analysis were: positively evaluated work contents, the identification with the institution, little time pressure and a positive working atmosphere.Conclusions: The assessed organisational framework is generally more favourable in the institutions of professional terminal care than in common hospitals and homes for old people. Therefore, the conditions in hospices could have a modelling function for the inner-institutional work organisation and for the anchorage of the intrinsic motivation of nurses in the

  6. Power-law sensitivity to initial conditions within a logisticlike family of maps: Fractality and nonextensivity

    Science.gov (United States)

    Costa, U. M. S.; Lyra, M. L.; Plastino, A. R.; Tsallis, C.

    1997-07-01

    Power-law sensitivity to initial conditions, characterizing the behavior of dynamical systems at their critical points (where the standard Liapunov exponent vanishes), is studied in connection with the family of nonlinear one-dimensional logisticlike maps xt+1=1-a\\|xt\\|z (z>1 00[Δx(t)/Δx(0)]=[1+(1-q)λqt]1/(1-q) (equal to eλ1t for q=1, and proportional, for large t, to t1/(1-q) for q≠1 q∈R is the entropic index appearing in the recently introduced nonextensive generalized statistics). The relation between the parameter q and the fractal dimension df of the onset-to-chaos attractor is revealed: q appears to monotonically decrease from 1 (Boltzmann-Gibbs, extensive, limit) to -∞ when df varies from 1 (nonfractal, ergodiclike, limit) to zero.

  7. Sensitivity studies of reactor thermal limits under natural two-phase circulation conditions

    International Nuclear Information System (INIS)

    To describe adequately CHF and thermal limit and to help relate experimental data taken in apparata not prototypic of the reactor to actual conditions, it is necessary to consider the transient conduction in the heater in order to predict the variation in the wall temperature. The analytical model of the heater thermal response during low-mass flow two-phase natural circulation varying periodically with time is presented in this paper. The heat conduction equation in the heater is solved analytically for cylindrical and plane geometry and coupled with boiling heat flux correlations to obtain critical heat flux and thermal limit models. On the basis of the model developed, the sensitivity of thermal limit value to variation of different parameters (boiling heat flux behavior, oscillation amplitude and frequency of CHF and CHF temperature, heater characteristics) is investigated and comparison of model predictions with experiment is conducted. (author)

  8. Clutter sensitivity test under controlled field conditions Resonant Microstrip Patch Antenna (RMPA) sensor technology

    Energy Technology Data Exchange (ETDEWEB)

    NONE

    1996-06-27

    Theoretical research, controlled laboratory tests, and these field test results show that nonmetallic (and metallic) shallowly buried objects can be detected and imaged with the Resonant Microstrip Patch Antenna (RMPA) sensor. The sensor can be modeled as a high Q cavity which capitalizes on its resonant condition sensitivity to scattered waves from buried objects. When the RMPA sensor is swept over a shallowly buried object, the RMPA fed-point impedance (resistance), measured with a Maxwell bridge, changes by tens of percent. The significant change in unprocessed impedance data can be presented in two-dimensional and three-dimensional graphical displays over the survey area. This forms silhouette images of the objects without the application of computationally intensive data processing algorithms. Because RMPA employed electromagnetic waves to illuminate the shallowly buried object, a number of questions and issues arise in the decision to fund or deny funding of the reconfiguration of the RMPA technology into a nonmetallic (metallic) land mine detector.

  9. Modeling responses of Daphnia magna to pesticide pulse exposure under varying food conditions: intrinsic versus apparent sensitivity.

    NARCIS (Netherlands)

    Pieters, Barry J; Jager, Tjalling; Kraak, Michiel H S; Admiraal, Wim

    2006-01-01

    Recent studies showed that limiting food conditions resulted in either increased or decreased sensitivity of Daphnia magna to toxicants. It remained unclear whether these contrasting food-dependent alterations in toxicity resulted from differences in intrinsic sensitivity of the daphnids or from cha

  10. Targeting Medicare consumers. Managed care providers can make inroads by understanding preference and cost-sensitivity issues.

    Science.gov (United States)

    Stensrud, J; Sylvestre, E; Sivadas, E

    1997-01-01

    The authors' conjoint study provided valuable information on the preferences of the hugh Medicare-eligible and soon-to-be-eligible markets. Leading the list were hospitalization coverage, skilled nursing facilities, and out-of-area coverage. The task of defining choice sets was made easier and more meaningful by selecting the top six attributes for each respondent. Asking respondents to rank levels within each attribute and assessing the importance of the various levels provided a more robust estimate of consumer preferences. Using an innovative price-sensitivity method preserved the integrity of the data. The method minimized respondent fatigue and enabled the authors to gather price-sensitivity data from respondents who were not actually paying for their health services. Respondents preferred Supplemental F and Medicare products even though they placed more value on the qualities of alternative health care products. This suggests that managed care providers need to change consumer perceptions about their products. PMID:10169036

  11. Rural Area Deprivation and Hospitalizations Among Children for Ambulatory Care Sensitive Conditions.

    Science.gov (United States)

    Hale, Nathan; Probst, Janice; Robertson, Ashley

    2016-06-01

    This study examined the intersection of rurality and community area deprivation using a nine-state sample of inpatient hospitalizations among children (interaction of rurality and area deprivation. The study found rural counties are disproportionality represented among the most deprived. Within the least deprived counties, the likelihood of an ACSC hospitalization was significantly lower in rural than among their urban counterparts. However, this rural advantage declines as the level of deprivation increases, suggesting the effect of rurality becomes more important as social and economic advantage deteriorates. We also found ACSC hospitalization to be much higher among racial/ethnic minority children and those with Medicaid or self-pay as an anticipated source of payment. These findings further contribute to the existing body of evidence documenting racial/ethnic disparities in important health related outcomes. PMID:26516019

  12. Antibiotic sensitivity of Enterobacteriaceae at a tertiary care center in India

    Directory of Open Access Journals (Sweden)

    Summaiya Mulla

    2011-01-01

    Full Text Available Aims and Objectives: It has been observed that various microorganisms are acquiring resistance to most of the available potent antibiotics; hence, there is a need for every hospital to follow the use of antibiotics according to antibiotic sensitivity pattern in that particular hospital or geographical area. It has been reported that Enterobacteriaceae group of microorganisms are increasingly acquiring resistance to many antibiotics and this resistance varies geographically. As there is a short of recent data with respect to Indian hospital, this particular study was designed with the aim of establishing sensitivity pattern of Enterobacteriaceae group of microorganisms to various antibiotics. Materials and Methods: Data of antibiotic sensitivity from December 2010 to April 2011 of different Enterobacteriaceae was taken from the Department of Microbiology, Govt. Medical College, Surat. Sensitivity of different Enterobacteriaceae was shown as using descriptive statistics. Results: E. coli (55.6% and Klebsiella (31.2% were the most frequent bacteria isolated. Enterobacteriaceae were very less sensitive to amoxicillin + clavulanic acid (13.7%, chloramphenicol (7.6%, cefoperazone (14.4%, cefixime (15.7%, and cefuroxime (17.6. Sensitivity to aztreonam was 32.7%. Sensitivity to carbapenem group of drugs included in this study, i.e., meropenem was 69.8%. Highest sensitivity was shown for ceftazidime (74.1%. E. coli is more sensitive to meropenem as compared with Klebsiella. Conclusion: Sensitivity of Enterobacteriaceae group of microorganisms to known antibiotics is decreasing. Decreased sensitivity to carbapenem group of antibiotics is a matter of concern.

  13. Associations of Caregiver Stress with Working Conditions, Caregiving Practices, and Child Behaviour in Home-Based Child Care

    Science.gov (United States)

    Rusby, Julie C.; Jones, Laura Backen; Crowley, Ryann; Smolkowski, Keith

    2013-01-01

    Home-based child caregivers face unique stressors related to the nature of their work. One hundred and fifty-five home-based child care providers in Oregon, USA, participated in this cross-sectional correlational study. We investigated associations between indicators of caregiver stress and child care working conditions, the quality of caregiver…

  14. Sensitivity of Pliocene climate simulations in MRI-CGCM2.3 to respective boundary conditions

    Science.gov (United States)

    Kamae, Youichi; Yoshida, Kohei; Ueda, Hiroaki

    2016-08-01

    Accumulations of global proxy data are essential steps for improving reliability of climate model simulations for the Pliocene warming climate. In the Pliocene Model Intercomparison Project phase 2 (PlioMIP2), a part project of the Paleoclimate Modelling Intercomparison Project phase 4, boundary forcing data have been updated from the PlioMIP phase 1 due to recent advances in understanding of oceanic, terrestrial and cryospheric aspects of the Pliocene palaeoenvironment. In this study, sensitivities of Pliocene climate simulations to the newly archived boundary conditions are evaluated by a set of simulations using an atmosphere-ocean coupled general circulation model, MRI-CGCM2.3. The simulated Pliocene climate is warmer than pre-industrial conditions for 2.4 °C in global mean, corresponding to 0.6 °C warmer than the PlioMIP1 simulation by the identical climate model. Revised orography, lakes, and shrunk ice sheets compared with the PlioMIP1 lead to local and remote influences including snow and sea ice albedo feedback, and poleward heat transport due to the atmosphere and ocean that result in additional warming over middle and high latitudes. The amplified higher-latitude warming is supported qualitatively by the proxy evidences, but is still underestimated quantitatively. Physical processes responsible for the global and regional climate changes should be further addressed in future studies under systematic intermodel and data-model comparison frameworks.

  15. Conditional Disease Development extracted from Longitudinal Health Care Cohort Data using Layered Network Construction.

    Science.gov (United States)

    Kannan, Venkateshan; Swartz, Fredrik; Kiani, Narsis A; Silberberg, Gilad; Tsipras, Giorgos; Gomez-Cabrero, David; Alexanderson, Kristina; Tegnèr, Jesper

    2016-01-01

    Health care data holds great promise to be used in clinical decision support systems. However, frequent near-synonymous diagnoses recorded separately, as well as the sheer magnitude and complexity of the disease data makes it challenging to extract non-trivial conclusions beyond confirmatory associations from such a web of interactions. Here we present a systematic methodology to derive statistically valid conditional development of diseases. To this end we utilize a cohort of 5,512,469 individuals followed over 13 years at inpatient care, including data on disability pension and cause of death. By introducing a causal information fraction measure and taking advantage of the composite structure in the ICD codes, we extract an effective directed lower dimensional network representation (100 nodes and 130 edges) of our cohort. Unpacking composite nodes into bipartite graphs retrieves, for example, that individuals with behavioral disorders are more likely to be followed by prescription drug poisoning episodes, whereas women with leiomyoma were more likely to subsequently experience endometriosis. The conditional disease development represent putative causal relations, indicating possible novel clinical relationships and pathophysiological associations that have not been explored yet. PMID:27211115

  16. Texture-defined objects influence responses of blowfly motion-sensitive neurons under natural dynamical conditions

    Directory of Open Access Journals (Sweden)

    Thomas W. Ullrich

    2014-04-01

    Full Text Available The responses of visual interneurons of flies involved in the processing of motion information do not only depend on the velocity, but also on other stimulus parameters, such as the contrast and the spatial frequency content of the stimulus pattern. These dependencies have been known for long, but it is still an open question how they affect the neurons’ performance in extracting information about the structure of the environment under the specific dynamical conditions of natural flight. Free-flight of blowflies is characterized by sequences of phases of translational movements lasting for just 30-100 milliseconds interspersed with even shorter and extremely rapid saccade-like rotational shifts in flight and gaze direction. Previous studies already analyzed how nearby objects, leading to relative motion on the retina with respect to a more distant background, influenced the response of a class of fly motion sensitive visual interneurons, the HS cells. In the present study, we focused on objects that differed from their background by discontinuities either in their brightness contrast or in their spatial frequency content. We found strong object-induced effects on the membrane potential even during the short intersaccadic intervals, if the background contrast was small and the object contrast sufficiently high. The object evoked similar response increments provided that it contained higher spatial frequencies than the background, but not under reversed conditions. This asymmetry in the response behavior is partly a consequence of the depolarization level induced by the background. Thus, our results suggest that, under the specific dynamical conditions of natural flight, i.e. on a very short timescale, the responses of HS cells represent object information depending on the polarity of the difference between object and background contrast and spatial frequency content.

  17. Effect of environments, mechanical conditions, and sensitization on crack growth and AE behavior during corrosion fatigue processes of sensitized 304 stainless steel

    International Nuclear Information System (INIS)

    Corrosion fatigue tests were conducted for sensitized 304 austenitic stainless ste el to investigate effects of environments, mechanical conditions, and sensitization on crack growth and AE (Acoustic Emission) behavior. The crack growth rates of specimens were found to be accelerated in air as compared with those in the solution treated case. Those obtained in transpassive region and at corrosion potential were more accelerated, due to superposition of the acceleration by sensitization and environmental effects such as intergranular corrosion, metal dissolution, or hydrogen evolved from cathodic reaction. The AE activity during crack growth was much higher than that of so lution treated specimens through all the δK values in this study. This indicates that AE techniques are very useful to monitor crack growth processes under sensitized condition. SEM observations of the sensitized fracture surfaces revealed that many microcracks were nucleated at grain boundaries perpendicularly to the main crack surfaces at higher δK than --34 MPa.m sup(1/2). These microcracks (separations) were concluded to be the main AE source during the crack growth in air under sensitized condition, since the numbers of the separations were proportional to the detected AE event counts. In addition to separations, intergranular-like cracks were observed on the sensitized fracture surfaces tested in transpassive region. The high AE activity (event count rate) at relatively low δK level was ascribed to the nucleation of these intergranular-like cracks shich arose from intergranular corrosion and triaxial stress in the crack tip plastic zone. (J.P.N.)

  18. Measuring health-related quality of life in adults with chronic conditions in primary care settings

    Science.gov (United States)

    Hand, Carri

    2016-01-01

    Abstract Objective To describe health-related quality of life (HRQOL) conceptual frameworks, critically review 3 commonly used HRQOL scales relevant to adults with chronic conditions in primary care settings, and make recommendations for using HRQOL scales in primary care practice. Data sources Information was accessed regarding HRQOL conceptual and theoretical approaches. A comprehensive search strategy identified 3 commonly used scales that met the review criteria and evidence regarding use of the scales in adults with chronic conditions in community settings. Scale selection Scales were selected if they were designed for clinical use; were easy to administer; were generic and broad in content areas; and contained some individualized items. Scales were critiqued according to content development, theoretical basis, psychometric properties, scoring, feasibility, the concepts being measured, and the number of items that measured an individualized concept. Synthesis Early HRQOL approaches focused on health and functional status while recent approaches incorporate individualized concepts such as the person’s own values and the environment. The abbreviated World Health Organization Quality of Life Scale (WHOQOL-BREF), the 36-Item Short Form Health Survey (SF-36), and the Duke Health Profile were critiqued. All address physical, mental, and social domains, while the WHOQOL-BREF also addresses environment. Psychometric evidence supports use of the SF-36 and WHOQOL-BREF with this population. The SF-36 has the most evidence of responsiveness but has some floor and ceiling effects, while the WHOQOL-BREF does not appear to have floor or ceiling effects but has limited evidence of responsiveness. The WHOQOL-BREF has the highest proportion of individualized items. Conclusion Measurement of HRQOL in adults with chronic conditions can support patient management and contribute to primary care service evaluation. Scales that are based on a broad definition of health and that

  19. Sensitivity of an asymmetric, three-dimensional diffuser to inlet condition perturbations

    International Nuclear Information System (INIS)

    Highlights: • Plasma actuators were used to manipulate secondary flow in the inlet of a diffuser. • Pulsed and steady forcing produce opposite effects on diffuser pressure recovery. • Planes of 2D PIV data were obtained from the midplane to the expanding sidewall. • Pulsed forcing produces a peak in Reynolds shear stress just upstream of separation. • Steady forcing leads to a differently-oriented large and unsteady separation bubble. - Abstract: The sensitivity of a three-dimensional, asymmetric diffuser to inlet condition perturbations was investigated using dielectric barrier discharge plasma actuators. Previous experimental and computational studies revealed the sensitivity of the separated flow in this diffuser to secondary flows in the inlet duct of the diffuser. By purposefully altering these secondary flows with highly tunable plasma actuators, the diffuser’s pressure recovery could be both significantly improved and degraded. Two cases, one with pulsed forcing and another with continuous forcing, were selected for further study using 2D particle image velocimetry (PIV). PIV data were acquired in five streamwise-wall-normal planes. These measurements reveal that the relatively weak spanwise forcing introduced by the plasma actuators changes the size and orientation of the separation bubble. Pulsed forcing produces a strong peak in the Reynolds shear stress in the boundary layer upstream of separation. This significantly delays separation leading to a large increase in diffuser pressure recovery. In contrast, continuous plasma actuator forcing causes early separation on the diffuser sidewall, completely changing the separation geometry. This causes a larger and more unsteady separation bubble with higher reversed flow velocities which contribute to losses in the diffuser’s pressure recovery

  20. Sensitivity of regional ensemble data assimilation spread to perturbations of lateral boundary conditions

    Directory of Open Access Journals (Sweden)

    Rachida El Ouaraini

    2015-12-01

    Full Text Available The implementation of a regional ensemble data assimilation and forecasting system requires the specification of appropriate perturbations of lateral boundary conditions (LBCs, in order to simulate associated errors. The sensitivity of analysis and 6-h forecast ensemble spread to these perturbations is studied here formally and experimentally by comparing three different LBC configurations for the ensemble data assimilation system of the ALADIN-France limited-area model (LAM. While perturbed initial LBCs are provided by the perturbed LAM analyses in each ensemble, the three ensemble configurations differ with respect to LBCs used at 3- and 6-h forecast ranges, which respectively correspond to: (1 perturbed LBCs provided by the operational global ensemble data assimilation system (GLBC, which is considered as a reference configuration; (2 unperturbed LBCs (ULBC obtained from the global deterministic model; (3 perturbed LBCs obtained by adding random draws of an error covariance model (PLBC to the global deterministic system. A formal analysis of error and perturbation equations is first carried out, in order to provide an insight of the relative effects of observation perturbations and of LBC perturbations at different ranges, in the various ensemble configurations. Horizontal variations of time-averaged ensemble spread are then examined for 6-h forecasts. Despite the use of perturbed initial LBCs, the regional ensemble ULBC is underdispersive not only near the lateral boundaries, but also in approximately one-third of the inner area, due to advection during the data assimilation cycle. This artefact is avoided in PLBC through the additional use of non-zero LBC perturbations at 3- and 6-h ranges, and the sensitivity to the amplitude scaling of the covariance model is illustrated for this configuration. Some aspects of the temporal variation of ensemble spread and associated sensitivities to LBC perturbations are also studied. These results

  1. Care Coordination/Home Telehealth: the systematic implementation of health informatics, home telehealth, and disease management to support the care of veteran patients with chronic conditions.

    Science.gov (United States)

    Darkins, Adam; Ryan, Patricia; Kobb, Rita; Foster, Linda; Edmonson, Ellen; Wakefield, Bonnie; Lancaster, Anne E

    2008-12-01

    Between July 2003 and December 2007, the Veterans Health Administration (VHA) introduced a national home telehealth program, Care Coordination/Home Telehealth (CCHT). Its purpose was to coordinate the care of veteran patients with chronic conditions and avoid their unnecessary admission to long-term institutional care. Demographic changes in the veteran population necessitate VHA increase its noninstitutional care (NIC) services 100% above its 2007 level to provide care for 110,000 NIC patients by 2011. By 2011, CCHT will meet 50% of VHA's anticipated NIC provision. CCHT involves the systematic implementation of health informatics, home telehealth, and disease management technologies. It helps patients live independently at home. Between 2003 and 2007, the census figure (point prevalence) for VHA CCHT patients increased from 2,000 to 31,570 (1,500% growth). CCHT is now a routine NIC service provided by VHA to support veteran patients with chronic conditions as they age. CCHT patients are predominantly male (95%) and aged 65 years or older. Strict criteria determine patient eligibility for enrollment into the program and VHA internally assesses how well its CCHT programs meet standardized clinical, technology, and managerial requirements. VHA has trained 5,000 staff to provide CCHT. Routine analysis of data obtained for quality and performance purposes from a cohort of 17,025 CCHT patients shows the benefits of a 25% reduction in numbers of bed days of care, 19% reduction in numbers of hospital admissions, and mean satisfaction score rating of 86% after enrolment into the program. The cost of CCHT is $1,600 per patient per annum, substantially less than other NIC programs and nursing home care. VHA's experience is that an enterprise-wide home telehealth implementation is an appropriate and cost-effective way of managing chronic care patients in both urban and rural settings. PMID:19119835

  2. Preferences for health care and self-management among Dutch adolescents with chronic conditions: a Q-methodological investigation

    NARCIS (Netherlands)

    Jedeloo, S.; Staa, A.L. van; Latour, J.M.; Exel, N.J. van

    2009-01-01

    Adolescents with chronic conditions have to learn to self-manage their health in preparation for transitioning to adult care. Nurses often struggle with how to approach youth with chronic conditions successfully. Little is known about the preferences and attitudes of these young people themselves.

  3. Clinical nursing care for transgender patients with cancer.

    Science.gov (United States)

    Levitt, Nathan

    2015-06-01

    Transgender people often face barriers in their pursuit of receiving sensitive and informed health care, and many avoid preventive care and care for life threatening conditions because of those obstacles. This article focuses on cancer care of the transgender patient, as well as ways that nurses and other providers can help to create a transgender-sensitive healthcare environment. PMID:26000586

  4. Evaluation of Critical Operating Conditions for a Semi-batch Reactor by Complementary Use of Sensitivity and Divergence Criteria

    OpenAIRE

    De Maria, G.; Stefan, D.-N.

    2011-01-01

    This paper presents a comparison of several effective methods of deriving the critical feeding conditions for the case of a semi-batch catalytic reactor used for the acetoacetylation of pyrrole with diketene in homogeneous liquid phase. The reaction is known to be of high risk due to the very exothermic (polymerisation) side-reactions involving reactive diketene. In order to perform the sensitivity analysis, both the Morbidelli-Varma sensitivity criterion and div-methods were used, the latter...

  5. High sensitivity point-of-care device for direct virus diagnostics

    DEFF Research Database (Denmark)

    Kiilerich-Pedersen, Katrine; Dapra, Johannes; Cherré, Solène;

    2013-01-01

    Influenza infections are associated with high morbidity and mortality, carry the risk of pandemics, and pose a considerable economic burden worldwide. To improve the management of the illness, it is essential with accurate and fast point-of-care diagnostic tools for use in the field or at the pat...

  6. Interactions between modafinil and cocaine during the induction of conditioned place preference and locomotor sensitization in mice: Implications for addiction

    Science.gov (United States)

    Shuman, Tristan; Cai, Denise J.; Sage, Jennifer R.; Anagnostaras, Stephan G.

    2013-01-01

    Modafinil is a wake-promoting drug effective at enhancing alertness and attention with a variety of approved and off-label applications. The mechanism of modafinil is not well understood but initial studies indicated a limited abuse potential. A number of recent publications, however, have shown that modafinil can be rewarding under certain conditions. The present study assessed the reinforcing properties of modafinil using conditioned place preference and locomotor sensitization in mice. Experiment 1 examined a high dose of modafinil (75 mg/kg) as well as its interactions with cocaine (15 mg/kg). Cocaine alone and modafinil co-administered with cocaine induced sensitization of locomotor activity; modafinil alone showed little or no locomotor sensitization. Animals given modafinil alone, cocaine alone, and modafinil plus cocaine exhibited a strong and roughly equivalent place preference. When tested for sensitization using a low challenge dose of modafinil, cross-sensitization was observed in all cocaine-pretreated mice. Experiment 2 examined a low dose of modafinil that is similar to the dose administered to humans and has been shown to produce cognitive enhancements in mice. Low dose modafinil (0.75 mg/kg) did not produce conditioned place preference or locomotor sensitization. Together, these results suggest that modafinil has the potential to produce reward, particularly in cocaine addicts, and should be used with caution. However, the typical low dose administered likely moderates these effects and may account for lack of addiction seen in humans. PMID:22963989

  7. Sensitivity analysis of helicopter IMC decelerating steep approach and landing performance to navigation system parameters. [Instrument Meteorological Conditions

    Science.gov (United States)

    Karmali, M. S.; Phatak, A. V.; Bull, J. S.; Peach, L. L.; Demko, P. S.

    1984-01-01

    The present investigation is concerned with a sensitivity analysis of the Decelerated Steep Approach and Landing (DSAL) maneuver to on-board and ground-based navigation system parameters. The Instrument Meteorological Conditions (IMC) DSAL maneuver involves decelerating to zero range rate while tracking the localizer and glideslope. The considered study investigated the performance of the navigation systems using Constant Deceleration Profile (CDP) guidance and a six degrees glideslope trajectory. A closed-loop computer simulation of the UH1H helicopter DSAL system was developed for the sensitivity analysis. Conclusions on system performance parameter sensitivity are discussed.

  8. Gas migration in KBS-3 buffer bentonite. Sensitivity of test parameters to experimental boundary conditions

    International Nuclear Information System (INIS)

    In the current Swedish repository design concept, hydrogen gas can be generated inside a waste canister by anaerobic corrosion of the ferrous metal liner. If the gas generation rate exceeds the diffusion rate of gas molecules in the buffer porewater, gas will accumulate in the void-space of a canister until its pressure becomes large enough for it to enter the bentonite as a discrete gaseous phase. Three long tenn gas injection tests have been performed on cylinders of pre-compacted MX80 bentonite. Two of these tests were undertaken using a custom-designed constant volume and radial flow (CVRF) apparatus. Gas was injected at a centrally located porous filter installed in the clay before hydration. Arrangements were made for gas to flow to three independently monitored sink-filter arrays mounted around the specimen. Axial and radial total stresses and internal porewater pressures were continuously monitored. Breakthrough and peak gas pressures were substantially larger than the sum of the swelling pressure and the external porewater. The third test was performed. using an apparatus which radially constrains the specimen during gas flow. Observed sensitivity of the breakthrough and peak gas pressures to the test boundary conditions suggests that gas entry must be accompanied by dilation of the bentonite fabric. In other words, there is a tendency for the volume of the specimen to increase during this process. The experimental evidence is consistent with the flow of gas along a relatively small number of crack-like pathways which propagate through the clay as gas pressure increases. Gas entry and breakthrough under constant volume boundary conditions causes a substantial increase in the total stress and the internal porewater pressure. It is possible to determine the point at which gas enters the clay by monitoring changes in these parameters. Localisation of gas flow within multiple pathways results, in nonuniform discharge rates at the sinks. When gas injection

  9. Treated wastewater irrigation: uptake of pharmaceutical and personal care products by common vegetables under field conditions.

    Science.gov (United States)

    Wu, Xiaoqin; Conkle, Jeremy L; Ernst, Frederick; Gan, Jay

    2014-10-01

    Global water shortage is placing an unprecedented pressure on water supplies. Treated wastewater is a valuable water resource, but its reuse for agricultural irrigation faces a roadblock: the public concern over the potential accumulation of contaminants of emerging concern (CECs) into human diet. In the present study, we measured the levels of 19 commonly occurring pharmaceutical and personal care products (PPCPs) in 8 vegetables irrigated with treated wastewater under field conditions. Tertiary treated wastewater without or with a fortification of each PPCP at 250 ng/L, was used to irrigate crops until harvest. Plant samples at premature and mature stages were collected. Analysis of edible tissues showed a detection frequency of 64% and 91% in all vegetables from the treated wastewater and fortified water treatments, respectively. The edible samples from the two treatments contained the same PPCPs, including caffeine, meprobamate, primidone, DEET, carbamazepine, dilantin, naproxen, and triclosan. The total concentrations of PPCPs detected in edible tissues from the treated wastewater and fortified irrigation treatments were in the range of 0.01-3.87 and 0.15-7.3 ng/g (dry weight), respectively. Annual exposure of PPCPs from the consumption of mature vegetables irrigated with the fortified water was estimated to be only 3.69 μg per capita. Results from the present study showed that the accumulation of PPCPs in vegetables irrigated with treated wastewater was likely limited under field conditions. PMID:25211705

  10. Post-trial dopaminergic modulation of conditioned catalepsy: A single apomorphine induced increase/decrease in dopaminergic activation immediately following a conditioned catalepsy response can reverse/enhance a haloperidol conditioned and sensitized catalepsy response.

    Science.gov (United States)

    Oliveira, Lucas Rangel; Dias, Flávia Regina Cruz; Santos, Breno Garone; Silva, Jade Leal Loureiro; Carey, Robert J; Carrera, Marinete Pinheiro

    2016-09-15

    Haloperidol can induce catalepsy and this drug effect can be conditioned as well as sensitized to contextual cues. We used a paired/unpaired Pavlovian conditioning protocol to establish haloperidol catalepsy conditioned and sensitized responses. Groups of rats were given 10 daily catalepsy tests following administration of vehicle (n=24) or haloperidol (1.0mg/kg) either paired (n=18) or unpaired (n=18) to testing. Subsequently, testing for conditioning was conducted and conditioning and sensitization of catalepsy were observed selectively in the paired group. Immediately following a second test for catalepsy conditioning, the groups were subdivided into 4 vehicle groups, 3 unpaired haloperidol groups and 3 paired haloperidol groups and were given one of three post-trial treatments (vehicle, 0.05mg/kg or 2.0mg/kg apomorphine). One day later the conditioned catalepsy test 3 was carried out and on the next day, a haloperidol challenge test was performed. The post-trial apomorphine treatments had major effects on the paired groups upon both conditioning and the haloperidol challenge test. The low dose apomorphine post-trial treatment enhanced both the conditioned and the haloperidol sensitized catalepsy responses. The high dose apomorphine post-trial treatment eliminated conditioned catalepsy and eliminated the initial acute catalepsy response to haloperidol that was induced in the vehicle control groups. These results demonstrate the sensitivity of conditioned drug cues to modification by increases/decreases in activity of the dopamine system in the immediate post-trial interval after a conditioning trial. This demonstration that post-trial dopaminergic drug treatments can modify conditioned drug behavior has broad implications for conditioned drug effects. PMID:27173428

  11. Integrated community teams – promoting continuity of care for people with long-term neurological conditions (LTNCs)?

    OpenAIRE

    Aspinal, Fiona; Bernard, Sylvia; Gridley, Kate; Parker, Gillian

    2011-01-01

    Purpose The SDO funded study ‘Integrated services for people with long-term neurological conditions: evaluation of the impact of the National Service Framework’ aimed to identify what helps or hinders integrated services and identify models and practice for delivering continuity of care for people with LTNCs. Theory People’s experiences of integrated services were explored by thematically analysing the data using Freeman et al.’s [1, 2] definitions of continuity of care as a conceptual framew...

  12. Experiences of patients with cancer and their nurses on the conditions of spiritual care and spiritual interventions in oncology units

    OpenAIRE

    Rassouli, Maryam; Zamanzadeh, Vahid; Ghahramanian, Akram; Abbaszadeh, Abbas; Alavi-Majd, Hamid; Nikanfar, Alireza

    2015-01-01

    Background: Although nurses acknowledge that spiritual care is part of their role, in reality, it is performed to a lesser extent. The purpose of the present study was to explore nurses’ and patients’ experiences about the conditions of spiritual care and spiritual interventions in the oncology units of Tabriz. Materials and Methods: This study was conducted with a qualitative conventional content analysis approach in the oncology units of hospitals in Tabriz. Data were collected through purp...

  13. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    Directory of Open Access Journals (Sweden)

    Latour Judith

    2009-07-01

    Full Text Available Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs. Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 older inpatients admitted in 49 GEMUs during the year 2002–2003 for fall-related trauma as a tracer condition. Pertinent indicators for a chart abstraction tool, the Geriatric Care Tool (GCT, were developed and validated according to five dimensions: access to care, comprehensiveness, continuity of care, patient-centred care and appropriateness. Consensus methods were used to develop the content. Participants were experts representing eight main health care professions involved in GEMUs from 19 different sites. Items associated with high quality of care at each step of the multidisciplinary management of patients admitted due to falls were identified. The GCT was tested for intra- and inter-rater reliability using 30 medical charts reviewed by each of three independent and blinded trained nurses. Kappa and agreement measures between pairs of chart reviewers were computed on an item-by-item basis. Results Three quarters of 169 items identifying the process of care, from the case history to discharge planning, demonstrated good agreement (kappa greater than 0.40 and agreement over 70%. Indicators for the appropriateness of care showed less reliability. Conclusion Content validity and reliability results, as well as the feasibility of the process, suggest that the chart abstraction tool can gather standardized and pertinent clinical information for further evaluating quality of care in GEMU using admission due to falls as a tracer condition. However, the GCT

  14. The evidence base for professional and self-care prevention - caries, erosion and sensitivity

    OpenAIRE

    Twetman, Svante

    2015-01-01

    Background The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures. Methods A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinav...

  15. Use of the interRAI CHESS scale to predict mortality among persons with neurological conditions in three care settings.

    Directory of Open Access Journals (Sweden)

    John P Hirdes

    Full Text Available BACKGROUND: Persons with certain neurological conditions have higher mortality rates than the population without neurological conditions, but the risk factors for increased mortality within diagnostic groups are less well understood. The interRAI CHESS scale has been shown to be a strong predictor of mortality in the overall population of persons receiving health care in community and institutional settings. This study examines the performance of CHESS as a predictor of mortality among persons with 11 different neurological conditions. METHODS: Survival analyses were done with interRAI assessments linked to mortality data among persons in home care (n = 359,940, complex continuing care hospitals/units (n = 88,721, and nursing homes (n = 185,309 in seven Canadian provinces/territories. RESULTS: CHESS was a significant predictor of mortality in all 3 care settings for the 11 neurological diagnostic groups considered after adjusting for age and sex. The distribution of CHESS scores varied between diagnostic groups and within diagnostic groups in different care settings. CONCLUSIONS: CHESS is a valid predictor of mortality in neurological populations in community and institutional care. It may prove useful for several clinical, administrative, policy-development, evaluation and research purposes. Because it is routinely gathered as part of normal clinical practice in jurisdictions (like Canada that have implemented interRAI assessment instruments, CHESS can be derived without additional need for data collection.

  16. Quality and coordination of care for patients with multiple conditions: results from an international survey of patient experience.

    Science.gov (United States)

    Burgers, Jako S; Voerman, Gerlienke E; Grol, Richard; Faber, Marjan J; Schneider, Eric C

    2010-09-01

    Previous studies using clinical performance measures suggest that quality of care for patients with multiple chronic conditions is not worse than that for others. This article presents patient-reported experiences of health care among 8,973 of chronically ill adults from eight countries, using telephone survey data. We designed a ''morbidity score'' combining the number of conditions and reported health status. Respondents with high morbidity scores reported less favorable experience with coordination of care compared to those with low morbidity scores. They also reported lower ratings of overall quality of care. There were no differences in reported experience with the individual physicians. Comparing type of comorbidity, chronic lung, and mental health problems were associated with lower ratings than hypertension, heart disease, diabetes, arthritis, and cancer. The implications and limitations of this study are discussed in the context of health care reform. Pay-for-performance programs need to account for chronic conditions to avoid penalizing physicians who care for larger shares of such patients. PMID:20801976

  17. Variation In Accountable Care Organization Spending And Sensitivity To Risk Adjustment: Implications For Benchmarking.

    Science.gov (United States)

    Rose, Sherri; Zaslavsky, Alan M; McWilliams, J Michael

    2016-03-01

    Spending targets (or benchmarks) for accountable care organizations (ACOs) participating in the Medicare Shared Savings Program must be set carefully to encourage program participation while achieving fiscal goals and minimizing unintended consequences, such as penalizing ACOs for serving sicker patients. Recently proposed regulatory changes include measures to make benchmarks more similar for ACOs in the same area with different historical spending levels. We found that ACOs vary widely in how their spending levels compare with those of other local providers after standard case-mix adjustments. Additionally adjusting for survey measures of patient health meaningfully reduced the variation in differences between ACO spending and local average fee-for-service spending, but substantial variation remained, which suggests that differences in care efficiency between ACOs and local non-ACO providers vary widely. Accordingly, measures to equilibrate benchmarks between high- and low-spending ACOs--such as setting benchmarks to risk-adjusted average fee-for-service spending in an area--should be implemented gradually to maintain participation by ACOs with high spending. Use of survey information also could help mitigate perverse incentives for risk selection and upcoding and limit unintended consequences of new benchmarking methodologies for ACOs serving sicker patients. PMID:26953298

  18. Computer aided diagnosis for mental health care : On the clinical validation of sensitive machines

    NARCIS (Netherlands)

    Sluis, F. van der; Dijkstra, T.; Broek, E.L. van den

    2012-01-01

    This study explores the feasibility of sensitive machines; that is, machines with empathic abilities, at least to some extent. A signal processing and machine learning pipeline is presented that is used to analyze data from two studies in which 25 Post-Traumatic Stress Disorder (PTSD) patients parti

  19. Methods for treating and conditioning of 14C containing health care waste

    International Nuclear Information System (INIS)

    Health care radioactive waste was previously accepted at Necsa and disposed of on this site in near-surface trenches. This practice was terminated by the regulator during 1997 and since then waste drums have been stored and have now become a Necsa liability. These waste drums containing unknown quantities of 14C. About 2500 drums have been accumulated over the years at the Necsa site. The 14C and 3H contents could not be determined with non-destructive assay methods. A study to minimize the further accumulation of 14C containing health care waste was undertaken and some new regulations implemented to prevent further increase of the liability.The bio-hazardous nature of the waste proved to be the main complication in the development of appropriate characterization and conditioning methods. Possible methods to sterilize the waste as a first step were consequently investigated, and this regards two interesting options received attention. The first was the so-called Stericycle ETD process, during which the waste is shredded in an enclosed environment and then sterilized by means of a technique known as Electro Thermal De-activation, and the second was sterilization with Gamma rays. The latter method had the advantage that shredding and repacking were not required.Once the waste was sterilized the waste could be characterized. The most practical method to do this was to compact the drum in a supercompactor and to analyze the liquid released from the drum during compaction in a laboratory.Reasonably accurate estimates of the 14C contents of the waste packages were obtained in this way and at the same time the waste volume to be disposed of was reduced by at least a factor of four. The option to dispose of the waste without doing any quantification of the 14C was also investigated. This option does not require the waste drums to be opened and therefore no sterilization is required. Characterization is in this case limited to assaying the drums for nuclides that can be

  20. Assessing the Exposure and Relative Sensitivity of Native Freshwater Mussels to Environmental Stressors and Laboratory Conditions

    Science.gov (United States)

    1. Expands the database for pesticide toxicity on native freshwater mussels. 2. Aids in determining any potential differences in toxic sensitivity of gravid female mussel attributed to age and laboratory holding times. 3. Aids in determining potential differences in juvenile ...

  1. CULTURE AND SENSITIVITY OF BACTERIAL GROWTH FROM EXOTIC COWS SUFFERING FROM ENDOMETRITIS UNDER PAKISTANI CONDITIONS

    Directory of Open Access Journals (Sweden)

    Idrees Ali Zahid

    2004-04-01

    Full Text Available Bacteriology of endometritis and in vitro antibiotic sensitivity of the isolates in Holstein Friesian and Jersey cows maintained at Research Institute for Physiology of Animal Reproduction, Bhunikey, District Kasur were carried out. Out of 100 samples, 89 contained different strains of bacteria and 11 were found bacteriologically sterile. Different species of bacteria isolated from these samples were, Bacillus subtilis (08.99%, Corynebacterium pyogenes (19.10%, Escherichia coli (29.21%, Neisseria meningitides (03.37%, Staphylococcus aureus (23.60%, Streptococcus pneumonia (03.37% and Streptococcus pyogenes (12.36%. The in vitro antibiotic sensitivity test indicated that the highest number of isolates (92% were sensitive to neomycin, followed by doxycyline (89%. Clindramycin showed the lowest results in terms of in vitro antibiotic sensitivity (51%.

  2. Conditioned cues and the expression of stimulant sensitization in animals and humans

    OpenAIRE

    Vezina, Paul; Leyton, Marco

    2008-01-01

    Repeated intermittent exposure to psychostimulants can lead to long-lasting sensitization of the drugs' behavioral and biochemical effects. Such findings have figured importantly in recent theories of drug addiction proposing that sensitized nucleus accumbens (NAcc) dopamine (DA) overflow in particular acts in concert with other alterations in the neurochemistry of this nucleus to promote drug seeking and self-administration. Yet, experiments in rodents, nonhuman primates and humans have not ...

  3. Supply sensitive services in Swiss ambulatory care: An analysis of basic health insurance records for 2003-2007

    Directory of Open Access Journals (Sweden)

    Künzi Beat

    2010-11-01

    Full Text Available Abstract Background Swiss ambulatory care is characterized by independent, and primarily practice-based, physicians, receiving fee for service reimbursement. This study analyses supply sensitive services using ambulatory care claims data from mandatory health insurance. A first research question was aimed at the hypothesis that physicians with large patient lists decrease their intensity of services and bill less per patient to health insurance, and vice versa: physicians with smaller patient lists compensate for the lack of patients with additional visits and services. A second research question relates to the fact that several cantons are allowing physicians to directly dispense drugs to patients ('self-dispensation' whereas other cantons restrict such direct sales to emergencies only. This second question was based on the assumption that patterns of rescheduling patients for consultations may differ across channels of dispensing prescription drugs and therefore the hypothesis of different consultation costs in this context was investigated. Methods Complete claims data paid for by mandatory health insurance of all Swiss physicians in own practices were analyzed for the years 2003-2007. Medical specialties were pooled into six main provider types in ambulatory care: primary care, pediatrics, gynecology & obstetrics, psychiatrists, invasive and non-invasive specialists. For each provider type, regression models at the physician level were used to analyze the relationship between the number of patients treated and the total sum of treatment cost reimbursed by mandatory health insurance. Results The results show non-proportional relationships between patient numbers and total sum of treatment cost for all provider types involved implying that treatment costs per patient increase with higher practice size. The related additional costs to the health system are substantial. Regions with self-dispensation had lowest treatment cost for primary care

  4. Fast, sensitive point of care electrochemical molecular system for point mutation and select agent detection.

    Science.gov (United States)

    MacLeod, J A; Nemeth, A C; Dicke, W C; Wang, D; Manalili Wheeler, S; Hannis, J C; Collier, G B; Drader, J J

    2016-07-01

    Point of care molecular diagnostics benefits from a portable battery-operated device capable of performing a fast turnaround using reliable inexpensive cartridges. We describe a prototype device for performing a molecular diagnostics test for clinical and biodefense samples in 16 minutes using a prototype capable of an 8 minute PCR reaction, followed by hybridization and detection on an electrochemical microarray based on the i-STAT® system. We used human buccal swabs for hemochromatosis testing including in-device DNA extraction. Additional clinical and biodefense samples included influenza A and bacterial select agents Bacillus anthracis, Yersinia pestis and Francisella tularensis. PMID:27280174

  5. Evaluation of portable point-of-care CD4 counter with high sensitivity for detecting patients eligible for antiretroviral therapy.

    Directory of Open Access Journals (Sweden)

    Yukari C Manabe

    Full Text Available BACKGROUND: Accurate, inexpensive point-of-care CD4+ T cell testing technologies are needed that can deliver CD4+ T cell results at lower level health centers or community outreach voluntary counseling and testing. We sought to evaluate a point-of-care CD4+ T cell counter, the Pima CD4 Test System, a portable, battery-operated bench-top instrument that is designed to use finger stick blood samples suitable for field use in conjunction with rapid HIV testing. METHODS: Duplicate measurements were performed on both capillary and venous samples using Pima CD4 analyzers, compared to the BD FACSCalibur (reference method. The mean bias was estimated by paired Student's t-test. Bland Altman plots were used to assess agreement. RESULTS: 206 participants were enrolled with a median CD4 count of 396 (range; 18-1500. The finger stick PIMA had a mean bias of -66.3 cells/µL (95%CI -83.4-49.2, P500 cells/µL with a mean bias of -120.6 (95%CI -162.8, -78.4, P<0.001. The sensitivity (95%CI of the Pima CD4 analyzer was 96.3% (79.1-99.8% for a <250 cells/ul cut-off with a negative predictive value of 99.2% (95.1-99.9%. CONCLUSIONS: The Pima CD4 finger stick test is an easy-to-use, portable, relatively fast device to test CD4+ T cell counts in the field. Issues of negatively-biased CD4 cell counts especially at higher absolute numbers will limit its utility for longitudinal immunologic response to ART. The high sensitivity and negative predictive value of the test makes it an attractive option for field use to identify patients eligible for ART, thus potentially reducing delays in linkage to care and ART initiation.

  6. Prenatal Choline Availability Alters the Context Sensitivity of Pavlovian Conditioning in Adult Rats

    Science.gov (United States)

    Lamoureux, Jeffrey A.; Meck, Warren H.; Williams, Christina L.

    2008-01-01

    The effects of prenatal choline availability on Pavlovian conditioning were assessed in adult male rats (3-4 mo). Neither supplementation nor deprivation of prenatal choline affected the acquisition and extinction of simple Pavlovian conditioned excitation, or the acquisition and retardation of conditioned inhibition. However, prenatal choline…

  7. An insight into the sensitivity of maize to photoperiod changes under controlled conditions.

    Science.gov (United States)

    Chen, Qiang; Zhong, Hao; Fan, Xian-Wei; Li, You-Zhi

    2015-08-01

    Response of maize to photoperiods affects adaption of this crop to environments. We characterize the phenotypes of four temperate-adapted maize foundation parents, Huangzao 4, Chang 7-2, Ye 478 and Zheng 58, and two tropically adapted maize foundation parents, M9 and Shuang M9 throughout the growth stage under three constant photoperiod regimes in a daily cycle of 24 h at 28 °C, and analysed expression of 48 photoperiod response-associated genes. Consequently, long photoperiod (LP) repressed development of the tassels of photoperiod-sensitive maize lines at V9 stage, and caused subsequent failure in flowering; failure of photoperiod-sensitive maize lines in flowering under LP was associated with lower expression of flowering-related genes; photoperiod changes could make a marked impact on spatial layout of maize inflorescence. The larger oscillation amplitude of expression of photoperiod-responsive genes occurred in LP-sensitive maize lines. In conclusion, failure in development of tassels at V9 stage under LP is an early indicator for judging photoperiod sensitivity. The adaptation of temperate-adapted maize lines to LP is due to the better coordination of expression among photoperiod-sensing genes instead of the loss of the genes. High photoperiod sensitivity of maize is due to high expression of circadian rhythm-responding genes improperly early in the light. PMID:24910171

  8. Female genital cutting (FGC) and the ethics of care: community engagement and cultural sensitivity at the interface of migration experiences

    Science.gov (United States)

    2014-01-01

    Background Female Genital Cutting (FGC) anchored in a complex socio-cultural context becomes significant at the interface of access of health and social services in host countries. The practice of FGC at times, understood as a form of gender-based violence, may result in unjustifiable consequences among girls and women; yet, these practices are culturally engrained traditions with complex meanings calling for ethically and culturally sensitive health and social service provision. Intents and meanings of FGC practice need to be well understood before before any policies that criminalize and condemn are derived and implemented. FGC is addressed as a global public health issue with complex legal and ethical dimensions which impacts ability to access services, far beyond gender sensitivity. The ethics of terminology are addressed, building on the sustained controversial debate in regards to the delicate issue of conceptualization. An overview of international policies is provided, identifying the current trend of condemnation of FGC practices. Socio-cultural and ethical challenges are discussed in light of selected findings from a community-based research project. The illustrative examples provided focus on Western countries, with a specific emphasis on Canada. Discussion The examples provided converge with the literature confirming the utmost necessity to engage with the FGC practicing communities allowing for ethically sensitive strategies, reduction of harm in relation to systems of care, and prevention of the risk of systematic gendered stigmatization. A culturally competent, gender and ethically sensitive approach is argued for to ensure the provision of quality ethical care for migrant families in host countries. We argue that socio-cultural determinants such as ethnicity, migration, sex and gender need to be accounted for as integral to the social construction of FGC. Summary Working partnerships between the public health sector and community based organisations

  9. Estimating the prevalence of comorbid conditions and their effect on health care costs in patients with diabetes mellitus in Switzerland

    Directory of Open Access Journals (Sweden)

    Huber CA

    2014-10-01

    Full Text Available Carola A Huber,1 Peter Diem,2 Matthias Schwenkglenks,3 Roland Rapold,1 Oliver Reich1 1Department of Health Sciences, Helsana Group, Zürich, Switzerland; 2Department of Endocrinology, Diabetes and Clinical Nutrition, Inselspital, Bern University Hospital, and University of Bern, Bern, Switzerland; 3Institute of Social and Preventive Medicine, University of Zürich, Zürich, Switzerland Background: Estimating the prevalence of comorbidities and their associated costs in patients with diabetes is fundamental to optimizing health care management. This study assesses the prevalence and health care costs of comorbid conditions among patients with diabetes compared with patients without diabetes. Distinguishing potentially diabetes- and nondiabetes-related comorbidities in patients with diabetes, we also determined the most frequent chronic conditions and estimated their effect on costs across different health care settings in Switzerland. Methods: Using health care claims data from 2011, we calculated the prevalence and average health care costs of comorbidities among patients with and without diabetes in inpatient and outpatient settings. Patients with diabetes and comorbid conditions were identified using pharmacy-based cost groups. Generalized linear models with negative binomial distribution were used to analyze the effect of comorbidities on health care costs. Results: A total of 932,612 persons, including 50,751 patients with diabetes, were enrolled. The most frequent potentially diabetes- and nondiabetes-related comorbidities in patients older than 64 years were cardiovascular diseases (91%, rheumatologic conditions (55%, and hyperlipidemia (53%. The mean total health care costs for diabetes patients varied substantially by comorbidity status (US$3,203–$14,223. Patients with diabetes and more than two comorbidities incurred US$10,584 higher total costs than patients without comorbidity. Costs were significantly higher in patients with

  10. Discrepancies in assessing home care workers’ working conditions in a Norwegian home care service: differing views of stakeholders at three organizational levels

    OpenAIRE

    Andersen, Gunn Robstad; Westgaard, Rolf Harald

    2015-01-01

    Background: The present study is a follow-up study of factors contributing to an undesirable quality of work environment and sick leave rate in the home care services in a Norwegian municipality. The underlying assumption is that organizational discrepancies in the perceptions and appraisals of significant factors and processes in an organization have detrimental effects on the management of the organization and on work environment conditions. Thus, the study aim is to explore pot...

  11. The evidence base for professional and self-care prevention - caries, erosion and sensitivity

    Science.gov (United States)

    2015-01-01

    Background The aim of this conference paper was to examine the evidence base for primary and secondary prevention of dental caries, erosions and dentin hypersensitivity through professional and self-care measures. Methods A mapping of systematic reviews (SR) of literature was carried out in PubMed and the Cochrane library through April 2014 using established MeSH-terms and disease-related search words in various combinations. The search was restricted to SR's published in English or Scandinavian and all age groups were considered. The reference lists of the selected papers were hand-searched for additional review articles of potential interest. Meta-analyses, guidelines and treatment recommendations were considered only when SR's were lacking. In the event of updates or multiple systematic reviews covering the same topic, only the most recent article was included. No quality assessment of the systematic reviews was carried out. The quality of evidence was rated in four levels according to the GRADE scale. Results In total, 39 SR were included. For primary caries prevention, the quality of evidence was high for the use of fluoride toothpaste (with and without triclosan) and moderate for fluoride varnish and fissure sealants. The quality of evidence for fluoride gel, fluoride mouth rinse, xylitol gums and silver diamine fluoride (SDF) was rated as low. For secondary caries prevention and caries arrest, only fluoride interventions and SDF proved consistent benefits, although the quality of evidence was low. Likewise, the GRADE score for preventing erosions located in the enamel with fluoride supplements was low. The quality of evidence for various professional and self-care methods to prevent and manage dentine hypersensitivity was very low. Conclusions There are knowledge gaps in many domains of cariology and preventive dentistry that must be addressed and bridged through clinical research of good quality. PMID:26392204

  12. Sensitivity analyses of biodiesel thermo-physical properties under diesel engine conditions

    DEFF Research Database (Denmark)

    Cheng, Xinwei; Ng, Hoon Kiat; Gan, Suyin;

    2016-01-01

    This reported work investigates the sensitivities of spray and soot developments to the change of thermo-physical properties for coconut and soybean methyl esters, using two-dimensional computational fluid dynamics fuel spray modelling. The choice of test fuels made was due to their contrasting s...

  13. 42 CFR 485.711 - Condition of participation: Plan of care and physician involvement.

    Science.gov (United States)

    2010-10-01

    ... reviewed by a physician, or by a physical therapist or speech pathologist respectively. (a) Standard.... (1) For each patient there is a written plan of care established by the physician or by the physical therapist or speech-language pathologist who furnishes the services. (2) The plan of care for...

  14. STATISTICAL MODELING OF ELECTROCHEMICAL REACTIVATION CONDITIONS FOR DETECTING SENSITIZATION TO IGC OF AUSTENITIC STAINLESS STEEL TYPE 316L

    OpenAIRE

    Kriaa, A.; Hamdi, N.; K. Jbali; H. Sidhom

    2007-01-01

    The aim of this study was to determine optimum conditions of the DL EPR test in order to evaluate the highest values of the degree of sensitization (DOS) of a forged austenitic stainless steel type 316L, evaluated by the ratio Ir/Ia or Qr/Qa in %. The criteria of sensitization to the IGC corresponds to Ir/Ia >1% and Qr/Qa >1%. A model using a full factorial design has been established and the selected factors were the sweep rate (dE/dt), sulphuric acid concentration (H2SO4), ammonium th...

  15. Assessment of the radiation sensitivity of patients after conditioning irradiation as preparation for bone marrow or stem cell transplantation

    International Nuclear Information System (INIS)

    The knowledge on the radiation sensitivity of individual patients would allow a better planning of conditioning irradiation including the possibility of dose increase that might enhance the chance of a successful bone marrow or stem cell transplantation. The study was focused on the search of reliable and fast laboratory test procedures to predict the individual radiation sensitivity. Several blood tests were evaluated with respect to their appropriateness: mostly flow-cytometric test on lymphocytes: micronuclei, cell proliferation, apoptosis activation of cytokines and the total number of leucocytes, blood stem cells CD4+ and CD8+ lymphocytes, and a spectro-photometric test of blood plasma for the determination of the antioxidative capacity

  16. Depression, sense and sensitivity: on pre-diagnostic questioning about self-harm and suicidal inclination in the primary care consultation.

    Science.gov (United States)

    Miller, Paul K

    2013-01-01

    National Health Service directives in the UK specify that, in any primary care consultation where a patient either demonstrably has--or is suspected to have--depression, a 'direct question' should be asked regarding their thoughts or activities relating to self-harm or suicide. The evidence collected for this study, which takes the form of recorded interactions between doctors and patients in primary care settings, indicates that this is most commonly done post-diagnosis as an exercise in 'risk assessment' Suicidal ideation, however, is not only classified as a possible outcome of depression but also a core symptom of the condition and, consequently, such a question is sometimes asked prior to the diagnostic phase of the consultation, as a key step in reaching a depression diagnosis. This specific activity presents a general practitioner with an inferably difficult communicative task: how to raise the matter of suicide/self-harm when the patient does not already have a depression diagnosis as an interactional resource with which to make sense of its local relevance. Herein, using a conversation analytic method, techniques employed by general practitioners and patients in negotiating three of these potentially sensitive moments are examined. Analytic observations are then used to highlight a range of issues pertinent to the formulation of normative frames of 'good practice' in handling difficult clinical topics in situ. PMID:24851516

  17. CULTURE AND SENSITIVITY OF BACTERIAL GROWTH FROM EXOTIC COWS SUFFERING FROM ENDOMETRITIS UNDER PAKISTANI CONDITIONS

    OpenAIRE

    Idrees Ali Zahid

    2004-01-01

    Bacteriology of endometritis and in vitro antibiotic sensitivity of the isolates in Holstein Friesian and Jersey cows maintained at Research Institute for Physiology of Animal Reproduction, Bhunikey, District Kasur were carried out. Out of 100 samples, 89 contained different strains of bacteria and 11 were found bacteriologically sterile. Different species of bacteria isolated from these samples were, Bacillus subtilis (08.99%), Corynebacterium pyogenes (19.10%), Escherichia coli (29.21%), Ne...

  18. Quality-of-life results used to endorse changes in standard of care for recurrent platinum-sensitive ovarian cancer.

    Science.gov (United States)

    Chase, Dana M; Wenzel, Lari B; Monk, Bradley J

    2012-06-01

    Most women with ovarian cancer will suffer a recurrence. Unfortunately, although initial treatment can lead to undetectable disease, recurrent disease is often more challenging to control. As curative intent is less common after relapse, patients and doctors argue for improving quality-of-life (QoL) outcomes when therapies are selected. The article reviewed here discusses the QoL results of a trial in platinum-sensitive recurrent ovarian cancer where over 900 patients were randomized to the standard treatment (carboplatin and paclitaxel) versus carboplatin and pegylated liposomal doxorubicin. In the paper under evaluation, the standard of care is challenged based on a favorable clinical outcome in addition to QoL results in the experimental arm. PMID:22812551

  19. Medical Underwriting In Long-Term Care Insurance: Market Conditions Limit Options For Higher-Risk Consumers.

    Science.gov (United States)

    Cornell, Portia Y; Grabowski, David C; Cohen, Marc; Shi, Xiaomei; Stevenson, David G

    2016-08-01

    A key feature of private long-term care insurance is that medical underwriters screen out would-be buyers who have health conditions that portend near-term physical or cognitive disability. We applied common underwriting criteria based on data from two long-term care insurers to a nationally representative sample of individuals in the target age range (50-71 years) for long-term care insurance. The screening criteria put upper bounds on the current proportion of Americans who could gain coverage in the individual market without changes to medical underwriting practice. Specifically, our simulations show that in the target age range, approximately 30 percent of those whose wealth meets minimum industry standards for suitability for long-term care insurance would have their application for such insurance rejected at the underwriting stage. Among the general population-without considering financial suitability-we estimated that 40 percent would have their applications rejected. The predicted rejection rates are substantially higher than the rejection rates of about 20-25 percent of applicants in the actual market. In evaluating reforms for long-term care financing and their potential to increase private insurance rates, as well as to reduce financial pressure on public safety-net programs, policy makers need to consider the role of underwriting in the market for long-term care insurance. PMID:27503976

  20. Is disgust sensitive to classical conditioning as indexed by facial electromyography and behavioural responses?

    Science.gov (United States)

    Borg, Charmaine; Bosman, Renske C; Engelhard, Iris; Olatunji, Bunmi O; de Jong, Peter J

    2016-06-01

    Earlier studies provided preliminary support for the role of classical conditioning as a pathway of disgust learning, yet this evidence has been limited to self-report. This study included facial electromyographical (EMG) measurements (corrugator and levator muscles) and a behavioural approach task to assess participants' motivation-to-eat the actual food items (conditioned stimuli, CS). Food items served as CS and film excerpts of a woman vomiting served as unconditioned stimuli (US). Following acquisition the CS+ (neutral CS paired with US disgust) was rated as more disgusting and less positive. Notably, the conditioned response was transferred to the actual food items as evidenced by participants' reported lowered willingness-to-eat. Participants also showed heightened EMG activity in response to the CS+ which seemed driven by the corrugator indexing a global negative affect. These findings suggest that classical conditioning as a pathway of disgust learning can be reliably observed in subjective but not in disgust-specific physiological responding. PMID:25818005

  1. System-state and operating condition sensitive control method and apparatus for electric power delivery systems

    Science.gov (United States)

    Burns, III, William Wesley (Inventor); Wilson, Thomas George (Inventor)

    1978-01-01

    This invention provides a method and apparatus for determining a precise switching sequence for the power switching elements of electric power delivery systems of the on-off switching type and which enables extremely fast transient response, precise regulation and highly stable operation. The control utilizes the values of the power delivery system power handling network components, a desired output characteristic, a system timing parameter, and the externally imposed operating conditions to determine where steady state operations should be in order to yield desired output characteristics for the given system specifications. The actual state of the power delivery system is continuously monitored and compared to a state-space boundary which is derived from the desired equilibrium condition, and from the information obtained from this comparison, the system is moved to the desired equilibrium condition in one cycle of switching control. Since the controller continuously monitors the power delivery system's externally imposed operating conditions, a change in the conditions is immediately sensed and a new equilibrium condition is determined and achieved, again in a single cycle of switching control.

  2. Integrated Health Care Payment Methods: Typology, Evidence And Pre-Conditions Of Implementation

    OpenAIRE

    Igor M. Sheiman

    2014-01-01

    Many countries have recently started the search for new payments methods with the specific objective to encourage integration in health care delivery – teamwork of providers, their coordination and continuity of care. This paper suggests the typology of three major integrated payment methods – pay-for-performance, episode based bundled payment and global payment. A brief overview of these methods in the USA and Europe, including Russia, indicates that there is still no strong evidence of thei...

  3. Influence of variation of etching conditions on the sensitivity of PADC detectors with a new evaluation method

    International Nuclear Information System (INIS)

    At the Paul Scherrer Institut, a personal neutron dosimetry system based on chemically etched poly allyl diglycol carbonate (PADC) detectors and an automatic track counting (Autoscan 60) for neutron dose evaluations has been in routine use since 1998. Today, the hardware and the software of the Autoscan 60 are out of date, no spare components are available anymore and more sophisticated image-analysis systems are already developed. Therefore, a new evaluation system, the 'TASLIMAGE', was tested thoroughly in 2009 for linearity, reproducibility, influence of etching conditions and so forth, with the intention of replacing the Autoscan 60 in routine evaluations. The TASLIMAGE system is based on a microscope (high-quality Nikon optics) and an ultra-fast three-axis motorised control for scanning the detectors. In this paper, the TASLIMAGE system and its possibilities for neutron dose calculation are explained in more detail and the study of the influence of the variation of etching conditions on the sensitivity and background of the PADC detectors is described. The etching temperature and etching duration were varied, which showed that the etching conditions do not have a significant influence on the results of non-irradiated detectors. However, the sensitivity of irradiated detectors decreases by 5 % per 1 deg. C when increasing the etching temperature. For the variation of the etching duration, the influence on the sensitivity of irradiated detectors is less pronounced. (authors)

  4. Influence of variation of etching conditions on the sensitivity of PADC detectors with a new evaluation method.

    Science.gov (United States)

    Fiechtner-Scharrer, A; Mayer, S; Boschung, M; Whitelaw, A

    2011-03-01

    At the Paul Scherrer Institut, a personal neutron dosimetry system based on chemically etched poly allyl diglycol carbonate (PADC) detectors and an automatic track counting (Autoscan 60) for neutron dose evaluations has been in routine use since 1998. Today, the hardware and the software of the Autoscan 60 are out of date, no spare components are available anymore and more sophisticated image-analysis systems are already developed. Therefore, a new evaluation system, the 'TASLIMAGE', was tested thoroughly in 2009 for linearity, reproducibility, influence of etching conditions and so forth, with the intention of replacing the Autoscan 60 in routine evaluations. The TASLIMAGE system is based on a microscope (high-quality Nikon optics) and an ultra-fast three-axis motorised control for scanning the detectors. In this paper, the TASLIMAGE system and its possibilities for neutron dose calculation are explained in more detail and the study of the influence of the variation of etching conditions on the sensitivity and background of the PADC detectors is described. The etching temperature and etching duration were varied, which showed that the etching conditions do not have a significant influence on the results of non-irradiated detectors. However, the sensitivity of irradiated detectors decreases by 5 % per 1°C when increasing the etching temperature. For the variation of the etching duration, the influence on the sensitivity of irradiated detectors is less pronounced. PMID:21212078

  5. Instrument Fault Detection Sensitivity of an Empirical Model under Accident Condition in NPPs

    International Nuclear Information System (INIS)

    After the recent accident in Fukushima, Japan, it has been proven that we cannot obtain fully reliable information from instruments during severe accident conditions. Although the reactor core really melted down, the RV water level indicator showed a more optimistic value than the actual conditions. Accordingly, plant operators were under the misunderstanding that the core was not exposed. This caused confusion for the incident response. Therefore, it is necessary to be equipped with a function that informs operators of the status of the instrument integrity in real time. If plant operators verify that the instruments are working properly during accident conditions, they able to make safer decisions. In an effort to solve this problem, we considered an empirical model using a Process Equipment Monitoring (PEM) tool as a method of instrument diagnosis in a nuclear power plant

  6. On the quench sensitivity of 7010 aluminum alloy forgings in the overaged condition

    Energy Technology Data Exchange (ETDEWEB)

    Tiryakioğlu, Murat, E-mail: m.tiryakioglu@unf.edu [School of Engineering, University of North Florida, Jacksonville, FL 32224 (United States); Robinson, Jeremy S. [Department of Mechanical, Aeronautical and Biomedical Engineering, University of Limerick, Limerick (Ireland); Eason, Paul D. [School of Engineering, University of North Florida, Jacksonville, FL 32224 (United States)

    2014-11-17

    The quench sensitivity of an overaged 7010 alloy forging was characterized by tensile and Vickers hardness tests, as well as scanning electron microscopy. Longitudinal tensile specimens, excised from a rectilinear open die forging were cooled from the solution treatment temperature following thirty-two different cooling paths including interrupted and delayed quenches. SEM analysis of the microstructure showed that quench precipitates were (i) Al{sub 2}CuMg (S) which nucleated heterogeneously on grain boundaries and (ii) Mg(Zn,Cu,Al){sub 2} (η) on grain boundaries, dispersoid bands, subgrain boundaries as well as in the aluminum matrix. The quench sensitivity of the alloy's yield strength and Vickers hardness was modeled simultaneously by quadruple-C curves, using an improved methodology for Quench Factor Analysis. The four C-curves used in the model represented loss of solute by (i) precipitation of S on grain boundaries, and precipitation of η (ii) on grain boundaries and dispersoid bands, (iii) on subgrain boundaries and (iv) in the matrix. The model yielded coefficient of determination (R{sup 2}) values of 0.967 and 0.974 for yield strength and Vickers hardness, respectively. The model and the implications of the results are discussed in this paper.

  7. On the quench sensitivity of 7010 aluminum alloy forgings in the overaged condition

    International Nuclear Information System (INIS)

    The quench sensitivity of an overaged 7010 alloy forging was characterized by tensile and Vickers hardness tests, as well as scanning electron microscopy. Longitudinal tensile specimens, excised from a rectilinear open die forging were cooled from the solution treatment temperature following thirty-two different cooling paths including interrupted and delayed quenches. SEM analysis of the microstructure showed that quench precipitates were (i) Al2CuMg (S) which nucleated heterogeneously on grain boundaries and (ii) Mg(Zn,Cu,Al)2 (η) on grain boundaries, dispersoid bands, subgrain boundaries as well as in the aluminum matrix. The quench sensitivity of the alloy's yield strength and Vickers hardness was modeled simultaneously by quadruple-C curves, using an improved methodology for Quench Factor Analysis. The four C-curves used in the model represented loss of solute by (i) precipitation of S on grain boundaries, and precipitation of η (ii) on grain boundaries and dispersoid bands, (iii) on subgrain boundaries and (iv) in the matrix. The model yielded coefficient of determination (R2) values of 0.967 and 0.974 for yield strength and Vickers hardness, respectively. The model and the implications of the results are discussed in this paper

  8. Sensitivity analysis of a dynamic food chain model DYNACON considering Korean agricultural conditions

    International Nuclear Information System (INIS)

    The sensitivity analysis of input parameters for a dynamic food chain model DYNACON was performed as a function of deposition time for the long-lived radionuclides (137Cs, 90Sr) and the selected foodstuffs (cereals, milk). The influence of input parameters for short and long-term contaminations of the foodstuffs after a deposition was also investigated. The input parameters were sampled using a Latin hypercube sampling (LHS) technique, and their sensitivity indices were quantified as partial rank correlation coefficient (PRCC). PRCCs were strongly dependent on the contamination period of foodstuffs as well as the deposition time of radionuclides. In case of deposition during growing stage of agricultural plants, the input parameters associated with contamination by foliar absorption were relatively influential in long-term contamination as well as short-term contamination. They were also influential in short-term contamination in case of deposition during non-growing stage. As the contamination period is longer, the influence of parameters associated with contamination by root uptake was increased. This phenomenon was more remarkable in case of the deposition during non-growing stage than growing stage, and in case of 90Sr deposition than 137Cs deposition. In case of deposition during growing stage of pasture, the characteristic parameters of cattle such as feed-milk transfer factor and daily intake rate were relatively influential in the contamination of milk. (author)

  9. Precipitation-climate sensitivity to initial conditions in an atmospheric general circulation model

    Energy Technology Data Exchange (ETDEWEB)

    Covey, C., LLNL

    1997-03-01

    Atmospheric climate, in contrast to weather, is traditionally considered to be determined by boundary conditions such as sea surface temperature (SST). To test this hypothesis, we examined annual mean precipitation from an ensemble of 20 general circulation model (GCM) simulations. Ensemble members were forced with identical 10-year series of SST and sea ice, but they began with slightly differing initial conditions. A surprisingly small proportion of the variance in the output is attributable to the effects of boundary forcing. This result-and similar evidence from smaller ensembles of other GCM simulations-implies that long-term precipitation variations are mostly unpredictable, even if SST forecasts are `perfect.`

  10. Sensitivity and specificity of a two-question screening tool for depression in a specialist palliative care unit.

    LENUS (Irish Health Repository)

    Payne, Ann

    2012-02-03

    OBJECTIVES: The primary objective in this study is to determine the sensitivity and specificity of a two-item screening interview for depression versus the formal psychiatric interview, in the setting of a specialist palliative in-patient unit so that we may identify those individuals suffering from depressive disorder and therefore optimise their management in this often-complex population. METHODS: A prospective sample of consecutive admissions (n = 167) consented to partake in the study, and the screening interview was asked separately to the formal psychiatric interview. RESULTS: The two-item questionnaire, achieved a sensitivity of 90.7% (95% CI 76.9-97.0) but a lower specificity of 67.7% (95% CI 58.7-75.7). The false positive rate was 32.3% (95% CI 24.3-41.3), but the false negative rate was found to be a low 9.3% (95% CI 3.0-23.1). A subgroup analysis of individuals with a past experience of depressive illness, (n = 95), revealed that a significant number screened positive for depression by the screening test, 55.2% (16\\/29) compared to those with no background history of depression, 33.3% (22\\/66) (P = 0.045). CONCLUSION: The high sensitivity and low false negative rate of the two-question screening tool will aid health professionals in identifying depression in the in-patient specialist palliative care unit. Individuals, who admit to a previous experience of depressive illness, are more likely to respond positively to the two-item questionnaire than those who report no prior history of depressive illness (P = 0.045).

  11. Plants sensitivity on nickel under different conditions of iron or calcium concentration in the nutrient medium

    Directory of Open Access Journals (Sweden)

    Renata Matraszek

    2013-12-01

    Full Text Available The sensitivity of six vegetable plants on nickel at early stages of their growth was investigated by index of tolerance. Besides the possibility of nickel fitostabilization by additional application of iron or calcium was tested. The experiment was conducted on Petri dishes. Different concentrations of nickel (0; 0,03; 0,06mM Ni as nickel sulphate, iron (0,05; O,OlmM Fe as Fe2+ citrate and calcium (0,50; 0,75; lmM Ca as calcium carbonate were added. Taking into consideration the sensitivity, investigated vegetables can be ordered in the following way: Cucurbita pepo conv. giromontiina L.>Lactuca sativa L.>Sinapis alba L.>Spinacia oleracea L.=Zea mays var. saccharata Kcke.>Phaseolus vulgaris L. Positive, statistically significant effect ofnickel fitostabilization (0,03 or 0,06mM Ni on elongative growth by the iron application (0,10mM Fe was shown for Zea mays var. saccharata Kcke independently of Ni concentration in the nutrient medium as well as for Sinapis alba L. and Phaseolus vulgaris L. in 0,06mM Ni. Addition as much as 0,75mM Ca in the presence 0,03mM Ni had positive result on Sinapis alba L and Phaseolus vulgaris L. seedlings as well as on Zea mays var. saccharata Kcke and Lactuca sativa L. roots and Cucurbita pepo convar. giromontiina L. shoots. Addition of 0,75mM Ca in the presence 0,06mM Ni promoted elongative growth of Zea mays var. saccharata Kcke seedlings. Application lmM Ca resulted in the promotion of elongative growth of Zea mays var. saccharata Kcke. roots (0,03mM Ni as well as Spinacia oleracea L. roots (0,06mM Ni.

  12. Perfect storm: organizational management of patient care under natural disaster conditions.

    Science.gov (United States)

    McCaughrin, William Cass; Mattammal, Maria

    2003-01-01

    Managing uncertainty is an essential attribute of organizational leadership and effectiveness. Uncertainty threatens optimal decision making by managers and, by extension, reduces the quality of patient care. Variation in the work flows of everyday patient caregiving reflects management's steps to control uncertainty, which include strategies for contending with potential disaster scenarios. Little exists in the literature that reveals how management's strategic response to controlling uncertainty in a real disaster event differs from strategies practiced in disaster simulations, with the goal of protecting patient care. Using organization theory, this article presents the application of uncertainty management to the catastrophic flooding of a major teaching hospital. A detailed description of management's strategies for patient rescue and evacuation is provided. Unique aspects of managing uncertainty stemming from a natural disaster are highlighted. Recommendations on organization responses to disasters that optimize patient care, safety, and continuity are offered to managers. PMID:14552099

  13. Effect of antecedent growth conditions on sensitivity of Escherichia coli to chlorine dioxide.

    OpenAIRE

    1982-01-01

    Bacterial resistance to inactivation by antibacterial agents that is induced by the growth environment was studied. Escherichia coli was grown in batch culture and in a chemostat, and the following parameters were varied: type of substrate, growth rate, temperature, and cell density during growth. Low doses (0.75 mg/liter) of chlorine dioxide were used to inactivate the cultures. The results demonstrated that populations grown under conditions that more closely approximated natural aquatic en...

  14. SENSITIVITY ANALYSIS USING DEHYDRATION PROCESS SIMULATION OF A CONDITIONING PLANT FOR NATURAL GAS

    OpenAIRE

    Eleonora Erdmann; Liliana Ale Ruiz; Leonel Benítez; Enrique Tarifa

    2012-01-01

    This paper describes the development of a steady simulator for the sectors of dehydration and stabilization of a natural gas treatment plant. The simulator was implemented by using the commercial simulator ASPEN HYSYS®. The gas considered in the simulation is a typical gas from deposits in the province of Salta (Argentina). The plant configuration and operating conditions adopted for the simulation are those generally used in the treatment of natural gas in Salta. With the developed simulator...

  15. Short-run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization

    OpenAIRE

    Jessamyn Schaller; Ann Huff Stevens

    2014-01-01

    Job loss in the United States is associated with long-term reductions in income and long-term increases in mortality rates. This paper examines the short- to medium-term changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 9800 individual job losses and longitudinal data on a wide variety of health-related measures and outcomes, we show that job loss results in worse self-reported health, includin...

  16. [The actual conditions and problems of terminal home nursing care at our hospital].

    Science.gov (United States)

    Hara, Tsuyoshi; Kawashiri, Hiroaki; Hirakata, Makoto; Yamasaki, Misaki; Sato, Mariko; Miura, Hiroshi; Murata, Tsuneari; Takagi, Hiroaki

    2009-12-01

    In 2006, we reconfirmed Suwachuo hospital slogan as "When there is a need of community, we will do our best to meet it" and the department of home nursing care is officially established in our hospital next spring. A death rate at home is generally used to evaluate a home nursing care, and this rate at our department was 60.8% in 2008. However, community needs various options in addition to death at home. Keeping an eye on community opinions is of great importance. PMID:20443392

  17. Applications of Conditional Nonlinear Optimal Perturbation to the Study of the Stability and Sensitivity of the Jovian Atmosphere

    Institute of Scientific and Technical Information of China (English)

    2006-01-01

    A two-layer quasi-geostrophic model is used to study the stability and sensitivity of motions on small-scale vortices in Jupiter's atmosphere. Conditional nonlinear optimal perturbations (CNOPs) and linear singular vectors (LSVs) are both obtained numerically and compared in this paper. The results show that CNOPs can capture the nonlinear characteristics of motions in small-scale vortices in Jupiter's atmosphere and show great difference from LSVs under the condition that the initial constraint condition is large or the optimization time is not very short or both. Besides, in some basic states, local CNOPs are found.The pattern of LSV is more similar to local CNOP than global CNOP in some cases. The elementary application of the method of CNOP to the Jovian atmosphere helps us to explore the stability of variousscale motions of Jupiter's atmosphere and to compare the stability of motions in Jupiter's atmosphere and Earth's atmosphere further.

  18. Relationship between absorptive lenses and contrast sensitivity in healthy young subjects with glare under photopic- and mesopic-vision conditions

    Science.gov (United States)

    Kanazawa, Masatsugu; Uozato, Hiroshi

    2013-05-01

    We investigated the effect of absorptive lenses on contrast sensitivity under photopic- and mesopic-visions with glare, from the viewpoint of luminous transmittance (LT) and spectral transmittance. The subjects were 24 healthy volunteers. Log contrast sensitivity (logCS) under two luminance conditions with glare was measured with a contrast glare test device. Binocular logCSs with absorptive lenses were compared with those without absorptive lenses (control condition). Furthermore, to investigate the effect of spectral transmittance, we calculated the ratio of stimulus quantity and the correlation between this ratio and logCS. Compared with that in the control, logCS was hardly affected in the case of high-luminous-transmittance absorptive lenses under binocular visions with glare. Middle- and long-wavelength lights effectively contribute to contrast sensitivity under photopic-vision and lights at each wavelength showed almost the same coefficients of correlation under mesopic-vision. Previous studies suggested that absorptive lenses provide users with protection against harmful radiation and glare. Our present results suggested that short-wavelength and high-LT absorptive lenses are particularly useful in daylight.

  19. Pairing of Customer’ Satisfaction with Brand Consciousness and Price Sensitivity (A Feminine Study in Pakistan on Beauty Care Products’ selection, Use and Satisfaction)

    OpenAIRE

    Saima Ulfat

    2013-01-01

    This research study targets the role of brand consciousness and price sensitivity in relation with satisfaction of females with their selected beauty care products. Data is collected from both working and non-working females via quota sampling primarily and convenience sampling as sub sampling. Responses of 108 females are collected via online Survey. In presented model, Satisfaction is appearing as dependent variable whereas Brand Consciousness and Price Sensitivity are appearing as independ...

  20. 42 CFR 418.56 - Condition of participation: Interdisciplinary group, care planning, and coordination of services.

    Science.gov (United States)

    2010-10-01

    ... professional roles: (i) A doctor of medicine or osteopathy (who is an employee or under contract with the hospice). (ii) A registered nurse. (iii) A social worker. (iv) A pastoral or other counselor. (2) If the... supervise the care and services. The hospice must designate a registered nurse that is a member of...

  1. Audio-visual speech timing sensitivity is enhanced in cluttered conditions.

    Directory of Open Access Journals (Sweden)

    Warrick Roseboom

    Full Text Available Events encoded in separate sensory modalities, such as audition and vision, can seem to be synchronous across a relatively broad range of physical timing differences. This may suggest that the precision of audio-visual timing judgments is inherently poor. Here we show that this is not necessarily true. We contrast timing sensitivity for isolated streams of audio and visual speech, and for streams of audio and visual speech accompanied by additional, temporally offset, visual speech streams. We find that the precision with which synchronous streams of audio and visual speech are identified is enhanced by the presence of additional streams of asynchronous visual speech. Our data suggest that timing perception is shaped by selective grouping processes, which can result in enhanced precision in temporally cluttered environments. The imprecision suggested by previous studies might therefore be a consequence of examining isolated pairs of audio and visual events. We argue that when an isolated pair of cross-modal events is presented, they tend to group perceptually and to seem synchronous as a consequence. We have revealed greater precision by providing multiple visual signals, possibly allowing a single auditory speech stream to group selectively with the most synchronous visual candidate. The grouping processes we have identified might be important in daily life, such as when we attempt to follow a conversation in a crowded room.

  2. Serotonin (2C) receptor regulation of cocaine-induced conditioned place preference and locomotor sensitization

    OpenAIRE

    Craige, Caryne P.; Unterwald, Ellen M.

    2012-01-01

    Previous studies have identified an inhibitory regulatory role of the 5-HT2C receptor in serotonin and dopamine neurotransmission. As cocaine is known to enhance serotonin and dopamine transmission, the ability of 5-HT2C receptors to modulate cocaine-induced behaviors was investigated. Alterations in cocaine reward behavior were assessed in the conditioned place preference (CPP) paradigm. Mice were injected with a selective 5-HT2C receptor agonist, Ro 60-0175 (0, 1, 3, 10 mg/kg, i.p.) prior t...

  3. Omission of expected reward sensitizes the brain dopaminergic system of classically conditioned Atlantic salmon

    DEFF Research Database (Denmark)

    Vindas, M.A.; Höglund, Erik; Folkedal, O.;

    across treatments and generations is one particularly attractive feature of fish model systems. Both animal welfare considerations and fundamental scientific questions regarding the evolution of learning and memory have directed particular attention towards possible cognitive and emotional processes in....... There was also a general downregulation of dopamine receptor D1 gene expression in the telencephalon of OER groups, which suggests a coping mechanism in response to unbalanced DA metabolism. These results indicate that animals subjected to unpredictable reward conditions develop a senzitation of the DA...

  4. Diagnostic agreement between a primary care physician and a teledermatologist for common dermatological conditions in North India

    Directory of Open Access Journals (Sweden)

    Binod Kumar Patro

    2015-01-01

    Full Text Available Background: Primary care physicians (PCPs encounter a large number of patients with dermatological diseases. However, delivering appropriate management is a challenge considering the inadequate dermatology training offered during the undergraduate medical curriculum. Teledermatology is the clinical evaluation of skin lesions by dermatologists and allows patients to be diagnosed and treated from a distant site. It is seen as a potential solution to the shortage of specialists and providing equitable service in remote areas. Aim: The study was aimed at estimating the diagnostic agreement of common dermatological conditions between a PCP and a teledermatologist. Materials and Methods: Consecutive patients with dermatological ailments who attended a primary health care clinic were recruited into the study, examined by the PCP and offered a diagnosis. The clinical images and patients′ history were collected and transferred to a dermatologist at a tertiary center who also made a diagnosis. Agreement between diagnosis made by the PCPs and the teledermatologist was measured using kappa (κ statistics. Results: Overall agreement between the diagnoses made by a PCP and the dermatologist was found to be 56%. Poor κ agreement (<0.4 was seen in the diagnosis of psoriasis and eczema. Conclusion: Teledermatology can supplement specialist dermatology service in remote areas. There was poor agreement in the diagnosis of psoriasis, classifying various types of eczematous conditions and fungal infections. Scarce manpower in dermatology at the primary health care level compounded by the burden of skin ailments necessitates training of PCPs in common dermatological conditions.

  5. Effect of operating conditions in soil aquifer treatment on the removals of pharmaceuticals and personal care products.

    Science.gov (United States)

    He, Kai; Echigo, Shinya; Itoh, Sadahiko

    2016-09-15

    Soil aquifer treatment (SAT) is an alternative advanced treatment for wastewater reclamation, and it has the potential to control micropollutants including pharmaceuticals and personal care products (PPCPs). However, the relationship of operating conditions in SAT and removals of micropollutants was not clear. In this study, the effects of operating conditions on the removals of PPCPs were evaluated by using lab-scale columns and plant pilot-scale reactors under different operating conditions. Firstly, weathered granite soil (WGS), standard sand (SAND) and Toyoura standard sand (TS) have different soil characteristics such as total organic carbon (TOC) and cation exchange capacity (CEC). In the columns with these packing materials, the removals of carboxylic analgesics and antilipidemics were effective regardless packing materials. The removals of antibiotics were more effective in WGS than in TS and SAND, indicating high TOC and CEC enhance the sorption in SAT. Secondly, with the extension of hydraulic retention time (HRT), the removals of sulfamethoxazole, acetaminophen, crotamiton, and antipyrine were improved in WGS columns, and adaptable biodegradation for moderately removable PPCPs was formed. Thirdly, the removal efficiencies of sulfamethoxazole and crotamiton were higher in the WGS column under vadose condition than in the WGS column under saturated condition, because of aerobic condition in WGS column under vadose condition. Though long HRT and vadose condition had positive influence on the removals of several PPCPs such as sulfamethoxazole, WGS column with an HRT of 7days under saturated condition removed most PPCPs. PMID:27213846

  6. Behavioural responses to thermal conditions affect seasonal mass change in a heat-sensitive northern ungulate.

    Directory of Open Access Journals (Sweden)

    Floris M van Beest

    Full Text Available BACKGROUND: Empirical tests that link temperature-mediated changes in behaviour (activity and resource selection to individual fitness or condition are currently lacking for endotherms yet may be critical to understanding the effect of climate change on population dynamics. Moose (Alces alces are thought to suffer from heat stress in all seasons so provide a good biological model to test whether exposure to non-optimal ambient temperatures influence seasonal changes in body mass. Seasonal mass change is an important fitness correlate of large herbivores and affects reproductive success of female moose. METHODOLOGY/PRINCIPAL FINDINGS: Using GPS-collared adult female moose from two populations in southern Norway we quantified individual differences in seasonal activity budget and resource selection patterns as a function of seasonal temperatures thought to induce heat stress in moose. Individual body mass was recorded in early and late winter, and autumn to calculate seasonal mass changes (n = 52 over winter, n = 47 over summer. We found large individual differences in temperature-dependent resource selection patterns as well as within and between season variability in thermoregulatory strategies. As expected, individuals using an optimal strategy, selecting young successional forest (foraging habitat at low ambient temperatures and mature coniferous forest (thermal shelter during thermally stressful conditions, lost less mass in winter and gained more mass in summer. CONCLUSIONS/SIGNIFICANCE: This study provides evidence that behavioural responses to temperature have important consequences for seasonal mass change in moose living in the south of their distribution in Norway, and may be a contributing factor to recently observed declines in moose demographic performance. Although the mechanisms that underlie the observed temperature mediated habitat-fitness relationship remain to be tested, physiological state and individual variation in

  7. Bacteriological profile and antibiotic sensitivity pattern of neonatal septicaemia in a rural tertiary care hospital in North India

    Directory of Open Access Journals (Sweden)

    S Thakur

    2016-01-01

    Full Text Available Background: There is not much published literature on neonatal septicemia available for the Sub-Himalayan region of North India. Hence, we undertook this study to find out the bacteriological profile and antibiotic sensitivity pattern of neonatal septicemia in the neonatal Intensive Care Unit. Material and Methods: Blood cultures were performed for all clinically suspected neonatal septicemia cases for 1-year. Identification of all pathogenic isolates was followed by antibiotic sensitivity testing. Results: We did blood cultures for 450 neonates and 42% were culture positive. Early onset sepsis were 92 (49% and 96 (51% were late onset sepsis. Gram-positive isolates were 60% and 40% were Gram-negative. Staphylococcus aureus (40%, coagulase negative Staphylococcus species (16%, non-fermenter group of organisms (NFGOs (15%, and Klebsiella pneumoniae (10% were the main isolates. Nasal cannula 101 (54%, birth asphyxia 91 (48%, and prematurity 73 (38% were the prominent risk factors associated with septicemia. Gram-positive organisms were highly resistant to penicillin (87% whereas Gram-negative isolates showed high resistance to third generation cephalosporins (53–89% and aminoglycosides (50–67%. The S. aureus isolates were methicillin-resistant in 41% whereas extended spectrum beta lactamase production was seen in 48% Gram-negative isolates.Conclusion: Our study highlights the recent emergence of Gram-positive organisms as predominant cause of neonatal septicemia in this part of Sub-Himalayan region, along with the review of literature which shows similar results from North India and rest of the world too. Though Gram-negative bacteria still remain the main cause of mortality in neonatal septicemia, we want to dispel the common notion among practitioners that they are the predominant isolates in neonatal septicemia.

  8. Person-Centered Care for Older Adults with Chronic Conditions and Functional Impairment: A Systematic Literature Review.

    Science.gov (United States)

    Kogan, Alexis Coulourides; Wilber, Kathleen; Mosqueda, Laura

    2016-01-01

    Person-centered care (PCC) shifts focus away from the traditional biomedical model in favor of embracing personal choice and autonomy for people receiving health services. It has become an important avenue for improving primary care, and older adults remain a priority target for PCC because they are more likely to have complex care needs than younger individuals. Nevertheless, despite a growing body of evidence regarding its use, PCC still lacks an agreed-upon definition. A literature review was conducted to explore extant scholarship on PCC for older adults, assess corresponding definitions of PCC, and identify important elements of quality PCC. Nearly 3,000 articles published between 1990 and 2014 were identified. Excluding search results outside the parameters of this study, the final review comprised 132 nonduplicate sources focused on patient-centered care or PCC in older adults. Fifteen descriptions of PCC were identified, addressing 17 central principles or values. The six most-prominent domains of PCC were holistic or whole-person care, respect and value, choice, dignity, self-determination, and purposeful living. The body of evidence reviewed suggests that PCC is an important area of growing interest. Although multiple definitions and elements of PCC abound-with many commonalities and some overlap-the field would benefit from a consensus definition and list of essential elements to clarify how to operationalize a PCC approach to health care and services for older adults. This work guided the development of a separate American Geriatrics Society expert panel statement presenting a standardized definition and a list of PCC elements for older adults with chronic conditions or functional impairment. PMID:26626408

  9. Electricity Bill Savings from Residential Photovoltaic Systems: Sensitivities to Changes in Future Electricity Market Conditions

    Energy Technology Data Exchange (ETDEWEB)

    Darghouth, Naim; Barbose, Galen; Wiser, Ryan

    2013-01-09

    This scoping study investigates the impact of, and interactions among, three key sources of uncertainty in the future value of bill savings from customer-sited PV, focusing in particular on residential customers. These three sources of uncertainty are: changes to electricity market conditions that would affect retail electricity prices, changes to the types of retail rate structures available to residential customers with PV, and shifts away from standard net-metering toward other compensation mechanisms for residential PV. We investigate the impact of a range of electricity market scenarios on retail electricity prices and rate structures, and the resulting effects on the value of bill savings from PV. The scenarios include various levels of renewable and solar energy deployment, high and low natural gas prices, the possible introduction of carbon pricing, and greater or lesser reliance on utility-scale storage and demand response. We examine the bill savings from PV with time-invariant, flat residential retail rates, as well as with time-varying retail rates, including time-of-use (TOU) rates and real-time pricing (RTP). In addition, we explore a flat rate with increasing-block pricing (IBP). We evaluate the bill savings from PV with net metering, as currently allowed in many states, as well as scenarios with hourly netting, a partial form of net metering. This scoping study is the first known effort to evaluate these types of interactions in a reasonably comprehensive fashion, though by no means have we considered every possible change to electricity market conditions, retail rate structures, or PV compensation mechanisms. It focuses solely on the private value of bill savings for residential PV and does not seek to quantify the broader social or economic cost or value of solar electricity. Our analysis applies assumptions based loosely on California’s electricity market in a future year (2030); however, it is neither intended to forecast California’s future

  10. Spectrum of Microbial Flora in Diabetic Foot Ulcer and Its Antibiotic Sensitivity Pattern in Tertiary Care Hospital in Ahmedabad, Gujarat

    Directory of Open Access Journals (Sweden)

    Manisha Jain

    2012-06-01

    Full Text Available Introduction: A Prospective study “Spectrum of Microbial flora in diabetic foot ulcer and its antibiotic sensitivity pattern” was carried out in a tertiary care hospital, Ahmedabad on 125 patients in which 85 were male patients and 40 were female patients. Material and Methods: Swabs samples were collected from the edge and margins of ulcers and organism were identified by gram staining culture and biochemical reactions. Results: Out of 125 specimens 108 specimens showed growth of organisms. Total 157 aerobic organisms were isolated from culture positive specimens. It represents an average of 1.25 organisms per case. Among these organisms, 130 gram negative and 27 gram positive organisms were isolated. Pseudomonas aeruginosa (30.57% was predominant organism followed by Klebsiella spp. (22.29%. Staphylococcus aureus were 12.74% in which Methicillin resistant S. aureus (MRSA was 55%. Conclusion: incidence of growth was 86.4% in which Pseudomonas aeruginosa (30.57% is most common isolate. Organisms in mixed infections showed multidrug resistance as compared to single isolated strain. Diabetic foot infections are polymicrobial in nature. As the Wagner’s grade increased, the prevalence of isolates also increased. [National J of Med Res 2012; 2(3.000: 354-357

  11. COMMON ORGANISMS AND ANTIBIOTIC SENSITIVITY OF E COLI IN URINARY TRACT INFECTION, IN A TERTIARY CARE TEACHING HOSPITAL, NORTHERN KERALA

    Directory of Open Access Journals (Sweden)

    Shanavas

    2015-11-01

    Full Text Available Urinary tract infection (UTI includes a spectrum of Asymptomatic Bacteruria (ABU, Cystitis, Prostitis and Pyelonephritis. Except in ABU, UTI is represented by symptomatic disease that warrants antimicrobial therapy. 1 Many of the studies have shown increasing antibiotic resistance to these agents. This study consists of a retrospective observational study of culture and sensitivity of 150 urinary samples, collected from patients who presented with symptoms of UTI, in a tertiary care teaching hospital, Northern Kerala, irrespective of their age and sex for a period of six months from June 2015 to November 2015. These results are then analyzed to find common organisms causing UTI in different age groups in either sex and their respective antibiotic resistance are noted. Out of 150 urinary samples 69.34% were sterile, while 30.66% were culture positive. Among the culture positive patients sex distribution was almost equal, with a slight female predominance, having a contribution of 54.35% females and 45.65% males. The most common organism was found to be E.coli, which contributed more than 50 per cent of total culture positivity (54.35%. Others include Staphylococci, Klebsiella Pnuemoniae, Proteus species, Pseudomonas, Enterococci, Candida Albicans etc. Collateral damage is an ecological adverse effect that resist the use of a highly efficacious drug to be considered as first line agent. Our study shows that drugs causing minimal collateral damages like Nitrofurantoin and Fosfomycin can be used as first line agent for treatment of UTI.

  12. A quantitative sensitivity analysis on the behaviour of common thermal indices under hot and windy conditions in Doha, Qatar

    Science.gov (United States)

    Fröhlich, Dominik; Matzarakis, Andreas

    2016-04-01

    Human thermal perception is best described through thermal indices. The most popular thermal indices applied in human bioclimatology are the perceived temperature (PT), the Universal Thermal Climate Index (UTCI), and the physiologically equivalent temperature (PET). They are analysed focusing on their sensitivity to single meteorological input parameters under the hot and windy meteorological conditions observed in Doha, Qatar. It can be noted, that the results for the three indices are distributed quite differently. Furthermore, they respond quite differently to modifications in the input conditions. All of them show particular limitations and shortcomings that have to be considered and discussed. While the results for PT are unevenly distributed, UTCI shows limitations concerning the input data accepted. PET seems to respond insufficiently to changes in vapour pressure. The indices should therefore be improved to be valid for several kinds of climates.

  13. Modeling regional aerosol variability over California and its sensitivity to emissions and long-range transport during the 2010 CalNex and CARES campaigns

    Directory of Open Access Journals (Sweden)

    J. D. Fast

    2014-03-01

    Full Text Available The performance of the Weather Research and Forecasting regional model with chemistry (WRF-Chem in simulating the spatial and temporal variations in aerosol mass, composition, and size over California is quantified using measurements collected during the California Nexus of Air Quality and Climate Experiment (CalNex and the Carbonaceous Aerosol and Radiative Effects Study (CARES conducted during May and June of 2010. The extensive meteorological, trace gas, and aerosol measurements collected at surface sites and along aircraft and ship transects during CalNex and CARES were combined with operational monitoring network measurements to create a single dataset that was used to evaluate the one configuration of the model. Simulations were performed that examined the sensitivity of regional variations in aerosol concentrations to anthropogenic emissions and to long-range transport of aerosols into the domain obtained from a global model. The configuration of WRF-Chem used in this study is shown to reproduce the overall synoptic conditions, thermally-driven circulations, and boundary layer structure observed in region that controls the transport and mixing of trace gases and aerosols. However, sub-grid scale variability in the meteorology and emissions as well as uncertainties in the treatment of secondary organic aerosol chemistry likely contribute to errors at a primary surface sampling site located at the edge of the Los Angeles basin. Differences among the sensitivity simulations demonstrate that the aerosol layers over the central valley detected by lidar measurements likely resulted from lofting and recirculation of local anthropogenic emissions along the Sierra Nevada. Reducing the default emissions inventory by 50% led to an overall improvement in many simulated trace gases and black carbon aerosol at most sites and along most aircraft flight paths; however, simulated organic aerosol was closer to observed when there were no adjustments to the

  14. Pairing of Customer’ Satisfaction with Brand Consciousness and Price Sensitivity (A Feminine Study in Pakistan on Beauty Care Products’ selection, Use and Satisfaction

    Directory of Open Access Journals (Sweden)

    Saima Ulfat

    2013-01-01

    Full Text Available This research study targets the role of brand consciousness and price sensitivity in relation with satisfaction of females with their selected beauty care products. Data is collected from both working and non-working females via quota sampling primarily and convenience sampling as sub sampling. Responses of 108 females are collected via online Survey. In presented model, Satisfaction is appearing as dependent variable whereas Brand Consciousness and Price Sensitivity are appearing as independent variables. Gathered data is analyzed while using Correlation Coefficient and Multiple Linear Regression. Results indicate a strongest relation of brand consciousness and price sensitivity along with satisfaction and females association with their selected beauty care products. Significance of this research is that manufacturing companies can use its results in order to enhance their marketing related efforts regarding this category of their brands especially with the context of Pakistani females.

  15. Critical System Cascading Collapse Assessment for Determining the Sensitive Transmission Lines and Severity of Total Loading Conditions

    Directory of Open Access Journals (Sweden)

    Nur Ashida Salim

    2013-01-01

    Full Text Available This paper presents a computationally accurate technique used to determine the estimated average probability of a system cascading collapse considering the effect of hidden failure on a protection system. This includes an accurate calculation of the probability of hidden failure as it will give significant effect on the results of the estimated average probability of system cascading collapse. The estimated average probability of a system cascading collapse is then used to determine the severe loading condition contributing to a higher risk of a system cascading collapse. This information is important because it will assist the utility to determine the maximum level of increase in the system loading condition before the occurrence of critical power system cascading collapse. Furthermore, the initial tripping of sensitive transmission line contributing to a critical system cascading collapse can also be determined by using the proposed method. Based on the results obtained from this study, it was found that selecting the accurate probability of hidden failure is very important as it will affect the estimated average probability of a system cascading collapse. Comparative study has been done with other techniques to verify the effectiveness of the proposed method used in the determination of sensitive transmission lines.

  16. Modeling responses of Daphnia magna to pesticide pulse exposure under varying food conditions: intrinsic versus apparent sensitivity.

    Science.gov (United States)

    Pieters, Barry J; Jager, Tjalling; Kraak, Michiel H S; Admiraal, Wim

    2006-10-01

    Recent studies showed that limiting food conditions resulted in either increased or decreased sensitivity of Daphnia magna to toxicants. It remained unclear whether these contrasting food-dependent alterations in toxicity resulted from differences in intrinsic sensitivity of the daphnids or from changes in toxicokinetics and resource allocation. It is hypothesized here that, if food level only affects accumulation kinetics and resource allocation, then the intrinsic sensitivity to this toxicant should be the same for all food regimes. This hypothesis was investigated using the DEBtox model, which is based on the theory of Dynamic Energy Budgets. We examined results of two recently conducted life-cycle studies on the combined effects of food level and a pulsed exposure to the pyrethroid insecticide fenvalerate (FV) on D. magna. The model described the effects of the time-varying exposure well, and indicated that when the animals did not die from exposure to FV, full reversibility of toxic effects was possible, allowing a complete recovery. Results revealed furthermore that the data from both studies could be described by the same NECs for survival and assimilation, killing rate and tolerance concentration (132 (49.2-228) x 10(-6) microg/L, 0 (0-1.18 x 10(-5)) microg/L, 74.4 (55.6-96.4) L (microg d)(-1) and 5.39 (2.72-18.5) x 10(-3) microg/L, respectively). It is therefore concluded that food-dependent FV toxicity can be explained by altered toxicokinetics and resource allocation, but not by changes in the intrinsic sensitivity of the daphnids. This study implies that the effect of pesticide application in the field depends on the trophic state of the receiving water body, but also that full recovery of survivors is possible after FV application. PMID:17024561

  17. Fate of Pharmaceuticals and Personal Care Products (PPCPs) in Saturated Soil Under Various Redox Conditions

    Science.gov (United States)

    Dror, I.; Menahem, A.; Berkowitz, B.

    2014-12-01

    The growing use of PPCPs results in their increasing release to the aquatic environment. Consequently, understanding the fate of PPCPs under environmentally relevant conditions that account for dynamic flow and varying redox states is critical. In this study, the transport of two organometallic PPCPs, Gd-DTPA and Roxarsone (As complex) and their metal salts (Gd(NO3)3, AsNaO2), is investigated. The former is used widely as a contrasting agent for MRI, while the latter is applied extensively as a food additive in the broiler poultry industry. Both of these compounds are excreted from the body, almost unchanged chemically. Gadolinium complexes are not fully eliminated in wastewater treatment and can reach groundwater via irrigation with treated wastewater; Roxarsone can enter groundwater via leaching from manure used as fertilizer. Studies have shown that the transport of PPCPs in groundwater is affected by environmental conditions such as redox states, pH, and soil type. For this study, column experiments using sand or Mediterranean red sandy clay soil were performed under several redox conditions: aerobic, nitrate-reducing, iron-reducing, sulfate-reducing, methanogenic, and very strongly chemical reducing. Batch experiments to determine adsorption isotherms were also performed for the complexes and metal salts. We found that Gd-DTPA transport was affected by the soil type and was not affected by the redox conditions. In contrast, Roxarsone transport was affected mainly by the different redox conditions, showing delayed breakthrough curves as the conditions became more biologically reduced (strong chemical reducing conditions did not affect the transport). We also observed that the metal salts show essentially no transport while the organic complexes display much faster breakthrough. The results suggest that transport of these PPCPs through soil and groundwater is determined by the redox conditions, as well as by soil type and the form of the applied metal (as salt

  18. SU-C-BRE-07: Sensitivity Analysis of the Threshold Energy for the Creation of Strand Breaks and of Single and Double Strand Break Clustering Conditions

    International Nuclear Information System (INIS)

    Purpose: To analyse the sensitivity of the creation of strand breaks (SB) to the threshold energy (Eth) and thresholding method and to quantify the impact of clustering conditions on single strand break (SSB) and double strand break (DSB) yields. Methods: Monte Carlo simulations using Geant4-DNA were conducted for electron tracks of 280 eV to 220 keV in a geometrical DNA model composed of nucleosomes of 396 phospho-diester groups (PDGs) each. A strand break was created inside a PDG when the sum of all energy deposits (method 1) or energy transfers (method 2) was higher than Eth or when at least one interaction deposited (method 3) or transferred (method 4) an energy higher than Eth. SBs were then clustered into SSBs and DSBs using clustering scoring criteria from the literature and compared to our own. Results: The total number of SBs decreases as Eth is increased. In addition, thresholding on the energy transfers (methods 2 and 4) produces a higher SB count than when thresholding on energy deposits (methods 1 and 3). Method 2 produces a step-like function and should be avoided when attempting to optimize Eth. When SBs are grouped into damage patterns, clustering conditions can underestimated SSBs by up to 18 % and DSBs can be overestimated by up to 12 % compared to our own implementation. Conclusion: We show that two often underreported simulation parameters have a non-negligible effect on overall DNA damage yields. First more SBs are counted when using energy transfers to the PDG rather than energy deposits. Also, SBs grouped according to different clustering conditions can influence reported SSB and DSB by as much as 20%. Careful handling of these parameters is required when trying to compare DNA damage yields from different authors. Research funding from the governments of Canada and Quebec. PP acknowledges partial support by the CREATE Medical Physics Research Training Network grant of the Natural Sciences and Engineering Research Council (Grant number: 432290)

  19. Lessons from Community Mental Health to Drive Implementation in Health Care Systems for People with Long-Term Conditions

    Directory of Open Access Journals (Sweden)

    Michele Tansella

    2014-04-01

    Full Text Available This paper aims to identify which lessons learned from the evidence and the experiences accruing from the transformation in mental health services in recent decades may have relevance for the future development of healthcare for people with long-term physical conditions. First, nine principles are discussed which we first identified to guide mental health service organisation, and all of which can be potentially applied to long term care as well (autonomy, continuity, effectiveness, accessibility, comprehensiveness, equity, accountability, co-ordination, and efficiency. Second, we have outlined innovative operational aspects of service user participation, many of which were first initiated and consolidated in the mental health field, and some of which are now also being implemented in long term care (including case management, and crisis plans. We conclude that long term conditions, whether mental or physical, deserve a long-term commitment from the relevant health services, and indeed where continuity and co-ordination are properly funded implemented, this can ensure that the symptomatic course is more stable, quality of life is enhanced, and the clinical outcomes are more favourable. Innovations such as self-management for long-term conditions (intended to promote autonomy and empowerment need to be subjected to the same level of rigorous scientific scrutiny as any other treatment or service interventions.

  20. A randomized study of telephonic care support in populations at risk for musculoskeletal preference-sensitive surgeries

    Directory of Open Access Journals (Sweden)

    Veroff David R

    2013-02-01

    Full Text Available Abstract Background The rate of elective surgeries varies dramatically by geography in the United States. For many of these surgeries, there is not clear evidence of their relative merits over alternate treatment choices and there are significant tradeoffs in short- and long-term risks and benefits of selecting one treatment option over another. Conditions and symptoms for which there is this lack of a single clear evidence-based treatment choice present great opportunities for patient and provider collaboration on decision making; back pain and joint osteoarthritis are two such ailments. A number of decision aids are in active use to encourage this shared decision-making process. Decision aids have been assessed in formal studies that demonstrate increases in patient knowledge, increases in patient-provider engagement, and reduction in surgery rates. These studies have not widely demonstrated the added benefit of health coaching in support of shared decision making nor have they commonly provided strong evidence of cost reductions. In order to add to this evidence base, we undertook a comparative study testing the relative impact on health utilization and costs of active outreach through interactive voice response technology to encourage health coaching in support of shared decision making in comparison to mailed outreach or no outreach. This study focused on individuals with back pain or joint pain. Methods We conducted four waves of stratified randomized comparisons for individuals with risk for back, hip, or knee surgery who did not have claims-based evidence of one or more of five chronic conditions and were eligible for population care management services within three large regional health plans in the United States. An interactive voice response (IVR form of outreach that included the capability for individuals to directly connect with health coaches telephonically, known as AutoDialog®, was compared to a control (mailed outreach or

  1. VitruCare: Using digital health to overcome the bounded willpower of patients with long term conditions

    Directory of Open Access Journals (Sweden)

    Carolyn Louise Wilson

    2015-09-01

    Full Text Available Background: Long term conditions affect 40% of the UK population whilst utilising 70% of the health and social care funding. Digital health has emerged as a solution, to aid patients in self-managing their health and alter unhealthy behaviours. However, for digital health to be effective, the field must have an understanding of what hinders or motivates patient behaviour change. Behavioural economics, as a combination of psychology and economics, can provide this knowledge with relevant concepts, biases and heuristics. One such concept is bounded willpower, which explains why people struggle to make decisions based on their long term interests but are more susceptible to short-term benefits or costs. Aims: The aim of this research is to explore the concept of bounded willpower in relation to digital health within the UK. The focus is primarily on the product VitruCare and its effectiveness at overcoming the bounded willpower of patients with long term conditions. Method: VitruCare used feedback, commitment contracts and channel factors to help overcome bounded willpower in an intervention on 144 patients in the Bradford region who were suffering from hypertension. Quantitative variables of patients’ weight, blood pressure, GP attendances, A&E attendances, acute admissions and outpatient visits were recorded before and after usage. A paired samples t-test was used to indicate significant differences in these two conditions. Results: Results indicated significant improvements in weight (t = 7.377, p = 0.000, systolic (t = 6.743, p = 0.000 and diastolic (t = 11.936, p = 0.000 blood pressure, alongside a significant reduction in GP practice visits (t = 12.643, p = 0.000 and outpatient visits (t = 5.951, p = 0.000. There were no significant differences in A&E attendances (t = 1.440, p = 0.152 and acute admissions (t = 1.029, p = 0.305. Conclusions: VitruCare's understanding of behavioural economics and the potential psychological pitfalls in the

  2. iMHere: A Novel mHealth System for Supporting Self-Care in Management of Complex and Chronic Conditions

    OpenAIRE

    Parmanto, Bambang; Pramana, Gede; Yu, Daihua Xie; Fairman, Andrea D.; Dicianno, Brad E.; McCue, Michael P

    2013-01-01

    Background Individuals with chronic conditions are vulnerable to secondary complications that can be prevented with adherence to self-care routines. They benefit most from receiving effective treatments beyond acute care, usually in the form of regular follow-up and self-care support in their living environments. One such population is individuals with spina bifida (SB), the most common permanently disabling birth defect in the United States. A Wellness Program at the University of Pittsburgh...

  3. Implementation of adolescent family-based substance use prevention programs in health care settings: Comparisons across conditions and programs.

    Science.gov (United States)

    Aalborg, Annette E; Miller, Brenda A; Husson, Gail; Byrnes, Hilary F; Bauman, Karl E; Spoth, Richard L

    2012-01-01

    BACKGROUND: The majority of knowledge related to implementation of family-based substance use prevention programs is based on programs delivered in school and community settings. The aim of this study is to examine procedures related to implementation effectiveness and quality of two family-based universal substance use prevention programs delivered in health care settings, the Strengthening Families Program: For Parents and Youth 10-14 (SFP) and Family Matters (FM). These evidence-based programs were delivered as part of a larger random control intervention study designed to assess the influence of program choice vs. assignment on study participation and adolescent substance use outcomes. We also assess the effects of program choice (vs. assignment to program) on program delivery. METHODS: A mixed method case study was conducted to assess procedures used to maximize implementation quality and fidelity of family-based prevention programs delivered in health care settings. Families with an 11 year old child were randomly selected for study participation from health plan membership databases of 4 large urban medical centers in the San Francisco Bay Area. Eligible families were initially randomized to a Choice study condition (families choose SFP or FM) or Assigned study condition (assigned to FM, SFP or control group); 494 ethnically diverse families were selected for participation in study programs. RESULTS: Successful implementation of family prevention programs in health care settings required knowledge of the health care environment and familiarity with established procedures for developing ongoing support and collaboration. Ongoing training of program deliverers utilizing data from fidelity assessment appeared to contribute to improved program fidelity over the course of the study. Families who chose FM completed the program in a shorter period (pprogram activities (p=0.02) compared to families assigned to FM. SFP "choice" families attended more sessions than

  4. HistoFlex-a microfluidic device providing uniform flow conditions enabling highly sensitive, reproducible and quantitative in situ hybridizations

    DEFF Research Database (Denmark)

    Søe, Martin Jensen; Okkels, Fridolin; Sabourin, David;

    2011-01-01

    for performing in the HistoFlex. The hybridization step was significantly enhanced using flow based incubations due to improved hybridization efficiency. The HistoFlex device enabled a fast miRNA ISH assay (3 hours) which provided higher hybridization signal intensity compared to using conventional techniques (5......A microfluidic device (the HistoFlex) designed to perform and monitor molecular biological assays under dynamic flow conditions on microscope slide-substrates, with special emphasis on analyzing histological tissue sections, is presented. Microscope slides were reversibly sealed onto a cast...... h 40 min). We further demonstrate that the improved hybridization efficiency using the HistoFlex permits more complex assays e. g. those comprising sequential hybridization and detection of two miRNAs to be performed with significantly increased sensitivity. The HistoFlex provides a new histological...

  5. Apomorphine induced conditioned place preference and sensitization is greater in rats exposed to unpredictable chronic mild stress.

    Science.gov (United States)

    Kanwal, Sumera; Ikram, Huma; Farhan, Muhammad; Haleem, Darakhshan Jabeen

    2015-11-01

    CNS stimulants are the class of the drugs that may be used to get relief from depression. Apomorphine is a D1 and D2 receptor agonist with a CNS stimulatory effect used for the treatment of Parkinson's disease is also abused. Although many drugs of abuse produce tolerance and dependence. Long term use of pshycostimulants produce reverse tolerance described as sensitization. These drugs also have a number of other beneficial effects but their therapeutic use is limited because of abuse potential. Conditioned place preference (CPP) test is used to monitor the reinforcing effect of drugs of abuse. Stress is an important factor that precipitates and potentiates addictive effects of different drugs of abuse. The present study was designed to investigate the addictive effect of apomorphine (1mg/kg) in rats previously exposed to repeated unpredictable chronic mild stress for 10 days (animal model of depression). Results from present study illustrate that unpredictable chronic mild stress potentiates the reinforcing effects of apomorphine as the number of entries and the time spent in the CPP compartment associated with drug administration is increased. Motor activity was taken as a parameter for behavioral sensitization which is induced by repeated administration of apomorphine, monitored as the number of cage crossings in light compartment of the CPP apparatus, also increased. PMID:26639488

  6. Talking about depression: a qualitative study of barriers to managing depression in people with long term conditions in primary care

    Directory of Open Access Journals (Sweden)

    Cherrington Andrea

    2011-03-01

    Full Text Available Abstract Background The risk of depression is increased in people with long term conditions (LTCs and is associated with poorer patient outcomes for both the depressive illness and the LTC, but often remains undetected and poorly managed. The aim of this study was to identify and explore barriers to detecting and managing depression in primary care in people with two exemplar LTCs: diabetes and coronary heart disease (CHD. Methods Qualitative in-depth interviews were conducted with 19 healthcare professionals drawn predominately from primary care, along with 7 service users and 3 carers (n = 29. One focus group was then held with a set of 6 healthcare professionals and a set of 7 service users and 1 carer (n = 14. Interviews and the focus group were digitally recorded, transcribed verbatim, and analysed independently. The two data sets were then inspected for commonalities using a constant comparative method, leading to a final thematic framework used in this paper. Results Barriers to detecting and managing depression in people with LTCs in primary care exist: i when practitioners in partnership with patients conceptualise depression as a common and understandable response to the losses associated with LTCs - depression in the presence of LTCs is normalised, militating against its recognition and treatment; ii where highly performanced managed consultations under the terms of the Quality and Outcomes Framework encourage reductionist approaches to case-finding in people with CHD and diabetes, and iii where there is uncertainty among practitioners about how to negotiate labels for depression in people with LTCs in ways that might facilitate shared understanding and future management. Conclusion Depression was often normalised in the presence of LTCs, obviating rather than facilitating further assessment and management. Furthermore, structural constraints imposed by the QOF encouraged reductionist approaches to case-finding for depression in

  7. Identification of brain nuclei implicated in cocaine-primed reinstatement of conditioned place preference: a behaviour dissociable from sensitization.

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    Robyn Mary Brown

    Full Text Available Relapse prevention represents the primary therapeutic challenge in the treatment of drug addiction. As with humans, drug-seeking behaviour can be precipitated in laboratory animals by exposure to a small dose of the drug (prime. The aim of this study was to identify brain nuclei implicated in the cocaine-primed reinstatement of a conditioned place preference (CPP. Thus, a group of mice were conditioned to cocaine, had this place preference extinguished and were then tested for primed reinstatement of the original place preference. There was no correlation between the extent of drug-seeking upon reinstatement and the extent of behavioural sensitization, the extent of original CPP or the extinction profile of mice, suggesting a dissociation of these components of addictive behaviour with a drug-primed reinstatement. Expression of the protein product of the neuronal activity marker c-fos was assessed in a number of brain regions of mice that exhibited reinstatement (R mice versus those which did not (NR mice. Reinstatement generally conferred greater Fos expression in cortical and limbic structures previously implicated in drug-seeking behaviour, though a number of regions not typically associated with drug-seeking were also activated. In addition, positive correlations were found between neural activation of a number of brain regions and reinstatement behaviour. The most significant result was the activation of the lateral habenula and its positive correlation with reinstatement behaviour. The findings of this study question the relationship between primed reinstatement of a previously extinguished place preference for cocaine and behavioural sensitization. They also implicate activation patterns of discrete brain nuclei as differentiators between reinstating and non-reinstating mice.

  8. Job mobility among parents of children with chronic health conditions: Early effects of the 2010 Affordable Care Act.

    Science.gov (United States)

    Chatterji, Pinka; Brandon, Peter; Markowitz, Sara

    2016-07-01

    We examine the effects of the 2010 Patient Protection and Affordable Care Act's (ACA) prohibition of preexisting conditions exclusions for children on job mobility among parents. We use a difference-in-difference approach, comparing pre-post policy changes in job mobility among privately-insured parents of children with chronic health conditions vs. privately-insured parents of healthy children. Data come from the 2004 and 2008 Survey of Income and Program Participation (SIPP). Among married fathers, the policy change is associated with about a 0.7 percentage point, or 35 percent increase, in the likelihood of leaving an employer voluntarily. We find no evidence that the policy change affected job mobility among married and unmarried mothers. PMID:27060524

  9. Primary health care nurses’ management practices of common mental health conditions in KwaZulu-Natal, South Africa

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    Faith N. Dube

    2015-02-01

    Full Text Available Background: Psychiatric conditions contribute to 13%of the global burden of diseases and account for one third of years lost because of disability (YLD. Despite the high prevalence of mental health problems, primary health care (PHC services remain ineffective in managing patients with mental health conditions.Objectives: The aim of the study was to determine the practices of PHC nurses in the management of psychiatric patients in primary health care clinics in one of the rural districts in South Africa.Method: A survey was conducted amongst nurses working in several PHC clinics in KwaZulu-Natal (KZN in order to determine their practices in the management of psychiatric patients. Mixed methods were used to determine the PHC nurses practices in the management of psychiatric patients.Results: The findings revealed that in five sites (83.3% treatments are not reviewed every six months, there were no local protocols on the administration of psychiatric emergency drugs, and none of the study sites provided psychiatric patients with education on their medication and its possible side effects.Conclusion: Based on the results of this study it is evident that psychiatric patients at PHC clinics in the district where the study was conducted do not receive quality treatment according to institutional mental health guidelines.

  10. Access to services, quality of care, and family impact for children with autism, other developmental disabilities, and other mental health conditions

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire

    2016-01-01

    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3–17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009–2010 National Survey of Children with Special Health Care Needs was utilized to examine the association between child’s special needs condition and three outcomes (N = 18,136): access to services (difficulty using services, difficulty getting referrals, lack of source of care, and inadequate insurance coverage), quality of care (lack of care coordination, lack of shared decision making, and no routine screening), and family impact (financial, employment, and time-related burden). Multivariate logistic regressions were performed to compare caregivers of children with autism spectrum disorders to caregivers of children with developmental disabilities (cerebral palsy, Down syndrome, developmental delay, or intellectual disability), mental health conditions (attention deficit hyperactivity disorder, anxiety, behavioral/conduct problems, or depression), or both developmental disabilities and mental health conditions. Caregivers of children with autism spectrum disorders were significantly more likely to report difficulty using services, lack of source of care, inadequate insurance coverage, lack of shared decision making and care coordination, and adverse family impact as compared to caregivers of children with developmental disabilities, mental health conditions, or both. PMID:24353274

  11. Primary care incidence and treatment of four neuropathic pain conditions: A descriptive study, 2002–2005

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    Carroll Dawn

    2008-05-01

    Full Text Available Abstract Background Between 1992 and 2001 the UK general practice incidence of post-herpetic neuralgia and trigeminal neuralgia declined, whilst the incidence of painful diabetic neuropathy increased. The most common first line treatments were compound analgesics. As therapeutic options have subsequently changed, this study presents updated data on incidence and prescribing patterns in neuropathic pain. Methods A descriptive analysis of the epidemiology and prescription treatment at diagnosis of incident post-herpetic neuralgia (n = 1,923; trigeminal neuralgia (1,862; phantom limb pain (57 and painful diabetic neuropathy (1,444 using computerised UK general practice records (THIN: May 2002 to July 2005. Results Primary care incidences per 100,000 person years observation of 28 (95% confidence interval (CI 27–30 for post-herpetic neuralgia, 27 (95%CI 26–29 for trigeminal neuralgia, 0.8 (95%CI 0.6–1.1 for phantom limb pain and 21 (95%CI 20–22 for painful diabetic neuropathy are reported. The most common initial treatments were tricyclic antidepressants (post-herpetic neuralgia or antiepileptics (trigeminal neuralgia and painful diabetic neuropathy and opioid analgesics (phantom limb pain. The mean number of changes before a stable drug regimen was 1.2 to 1.5 for trigeminal neuralgia, painful diabetic neuropathy and post-herpetic neuralgia, and 2.4 for phantom limb pain. Conclusion The incidence of phantom limb pain and post-herpetic neuralgia are decreasing whilst painful diabetic neuropathy plateaued and trigeminal neuralgia remained constant. Despite more frequent use of antidepressants and antiepileptics for first line treatment, as opposed to conventional non-opioid analgesics, changes to therapy are common before a stable regimen is reached.

  12. TRAK ontology: defining standard care for the rehabilitation of knee conditions.

    Science.gov (United States)

    Button, Kate; van Deursen, Robert W; Soldatova, Larisa; Spasić, Irena

    2013-08-01

    In this paper we discuss the design and development of TRAK (Taxonomy for RehAbilitation of Knee conditions), an ontology that formally models information relevant for the rehabilitation of knee conditions. TRAK provides the framework that can be used to collect coded data in sufficient detail to support epidemiologic studies so that the most effective treatment components can be identified, new interventions developed and the quality of future randomized control trials improved to incorporate a control intervention that is well defined and reflects clinical practice. TRAK follows design principles recommended by the Open Biomedical Ontologies (OBO) Foundry. TRAK uses the Basic Formal Ontology (BFO) as the upper-level ontology and refers to other relevant ontologies such as Information Artifact Ontology (IAO), Ontology for General Medical Science (OGMS) and Phenotype And Trait Ontology (PATO). TRAK is orthogonal to other bio-ontologies and represents domain-specific knowledge about treatments and modalities used in rehabilitation of knee conditions. Definitions of typical exercises used as treatment modalities are supported with appropriate illustrations, which can be viewed in the OBO-Edit ontology editor. The vast majority of other classes in TRAK are cross-referenced to the Unified Medical Language System (UMLS) to facilitate future integration with other terminological sources. TRAK is implemented in OBO, a format widely used by the OBO community. TRAK is available for download from http://www.cs.cf.ac.uk/trak. In addition, its public release can be accessed through BioPortal, where it can be browsed, searched and visualized. PMID:23665300

  13. Sensitivity of the invasive bivalve Corbicula fluminea to candidate control chemicals: The role of dissolved oxygen conditions.

    Science.gov (United States)

    Rosa, Inês C; Garrido, Rita; Ré, Ana; Gomes, João; Pereira, Joana L; Gonçalves, Fernando; Costa, Raquel

    2015-12-01

    The freshwater Corbicula fluminea is a major aquatic nuisance worldwide. Current pest control methods raise cost-effectiveness and environmental concerns, which motivate research into improved mitigation approaches. In this context, the susceptibility of the clams to chemicals under reduced oxygen conditions was examined. Biocides with different mechanisms of toxicity (niclosamide, polyDADMAC, ammonium nitrate, potassium chloride and dimethoate) were tested under normoxic (>7 mg L(-1) dissolved O2) and hypoxic (ammonium nitrate and dimethoate, clam mortality enhancements up to 400% were observed under hypoxia as compared to dosing upon normal dissolved oxygen conditions. For polyDADMAC and potassium chloride, substantially lower mortality enhancements were found. The differences in the clams' sensitivity to the chemicals under hypoxia could be linked to the expected mechanisms of action. This suggests that judicious selection of the biocide is essential if optimized combined control treatments are to be designed and provides an insight into the interference of frequent hypoxia events in the response of natural clam populations to contaminant loads. PMID:26254082

  14. Chloride transport and its sensitivities to different boundary conditions in reclaimed soil solutions filled with fly ash

    Institute of Scientific and Technical Information of China (English)

    Xiao-Yang CHEN; Jia-Ping YAN; Shi-Wen ZHANG

    2013-01-01

    Chloride ion transport in reclaimed soil solutions filled with fly ash (FA) was investigated by measuring the hydraulic parameters (i.e.water retention curves and hydraulic conductivity) of three substrates,namely GSL,GFA,and CFA.Similar simulations were carried out under certain weather conditions.The different boundary conditions of chloride transport were also discussed from FA texture,cover soil thickness,groundwater table level,and initial chloride concentration.Furthcrmore,the sensitivities of chloride ions to these effect factors were analyzed.The results show that the different top soil thickness and initial chloride concentration have no effect on salinity of topsoil solution in the monitoring points,but they can clearly change the chloride concentration of FA layers.The sensibilities from top soil thickness and initial chloride content are exceedingly weak to the salinity balance based on two dimensions of the time and concentration.While the different FA texture and groundwater table not only affect the salinity equilibrium process of the whole reclaimed soil profile,but also change its balance state.Generally,coarse FA particles and high groundwater table can defer the salinity balance process of the reclaimed soil solution,and they also increase the chloride concentration of FA layer solutions,and even topsoil ones.

  15. Information and Communication Technology–Enabled Person-Centered Care for the “Big Five” Chronic Conditions: Scoping Review

    Science.gov (United States)

    Simonse, Lianne WL

    2015-01-01

    Background Person-centered information and communication technology (ICT) could encourage patients to take an active part in their health care and decision-making process, and make it possible for patients to interact directly with health care providers and services about their personal health concerns. Yet, little is known about which ICT interventions dedicated to person-centered care (PCC) and connected-care interactions have been studied, especially for shared care management of chronic diseases. The aim of this research is to investigate the extent, range, and nature of these research activities and identify research gaps in the evidence base of health studies regarding the “big 5” chronic diseases: diabetes mellitus, cardiovascular disease, chronic respiratory disease, cancer, and stroke. Objective The objective of this paper was to review the literature and to scope the field with respect to 2 questions: (1) which ICT interventions have been used to support patients and health care professionals in PCC management of the big 5 chronic diseases? and (2) what is the impact of these interventions, such as on health-related quality of life and cost efficiency? Methods This research adopted a scoping review method. Three electronic medical databases were accessed: PubMed, EMBASE, and Cochrane Library. The research reviewed studies published between January 1989 and December 2013. In 5 stages of systematic scanning and reviewing, relevant studies were identified, selected, and charted. Then we collated, summarized, and reported the results. Results From the initial 9380 search results, we identified 350 studies that qualified for inclusion: diabetes mellitus (n=103), cardiovascular disease (n=89), chronic respiratory disease (n=73), cancer (n=67), and stroke (n=18). Persons with one of these chronic conditions used ICT primarily for self-measurement of the body, when interacting with health care providers, with the highest rates of use seen in chronic

  16. Variations in the Quality of Care at Large Public Hospitals in Beijing, China: A Condition-Based Outcome Approach.

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    Ye Xu

    Full Text Available Public hospitals deliver over ninety percent of all outpatient and inpatient services in China. Their quality is graded into three levels (A, B, and C largely based on structural resources, but empirical evidence on the quality of process and outcome of care is extremely scarce. As expectations for quality care rise with higher living standards and cost of care, such evidence is urgently needed and vital to improve care and to inform future health reforms.We compiled and analyzed a multicenter database of over 4 million inpatient discharge summary records to provide a comprehensive assessment of the level and variations in clinical outcomes of hospitalization at 39 tertiary hospitals in Beijing. We assessed six outcome measures of clinical quality: in-hospital mortality rates (RSMR for AMI, stroke, pneumonia and CABG, post-procedural complication rate (RS-CR, and failure-to-rescue rate (RS-FTR. The measures were adjusted for pre-admission patient case-mix using indirect standardization method with hierarchical linear mixed models.We found good overall quality with large variations by hospital and condition (mean/range, in %: RSMR-AMI: 6.23 (2.37-14.48, RSMR-stroke: 4.18 (3.58-4.44, RSMR-pneumonia: 7.78 (7.20-8.59, RSMR-CABG: 1.93 (1.55-2.23, RS-CR: 11.38 (9.9-12.88, and RS-FTR: 6.41 (5.17-7.58. Hospital grade was not significantly associated with any risk-adjusted outcome measures.Going to a higher grade public hospital does not always lead to better patient outcome because hospital grade only contains information about hospital structural resources. A hospital report card with some outcome measures of quality would provide valuable information to patients in choosing providers, and for regulators to identify gaps in health care quality. Reducing the variations in clinical practice and patient outcome should be a focus for policy makers in the next round of health sector reforms in China.

  17. Enzyme Immobilization Strategies and Electropolymerization Conditions to Control Sensitivity and Selectivity Parameters of a Polymer-Enzyme Composite Glucose Biosensor

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    Sharon A. Rothwell

    2010-06-01

    Full Text Available In an ongoing programme to develop characterization strategies relevant to biosensors for in-vivo monitoring, glucose biosensors were fabricated by immobilizing the enzyme glucose oxidase (GOx on 125 µm diameter Pt cylinder wire electrodes (PtC, using three different methods: before, after or during the amperometric electrosynthesis of poly(ortho-phenylenediamine, PoPD, which also served as a permselective membrane. These electrodes were calibrated with H2O2 (the biosensor enzyme signal molecule, glucose, and the archetypal interference compound ascorbic acid (AA to determine the relevant polymer permeabilities and the apparent Michaelis-Menten parameters for glucose. A number of selectivity parameters were used to identify the most successful design in terms of the balance between substrate sensitivity and interference blocking. For biosensors electrosynthesized in neutral buffer under the present conditions, entrapment of the GOx within the PoPD layer produced the design (PtC/PoPD-GOx with the highest linear sensitivity to glucose (5.0 ± 0.4 μA cm−2 mM−1, good linear range (KM = 16 ± 2 mM and response time (< 2 s, and the greatest AA blocking (99.8% for 1 mM AA. Further optimization showed that fabrication of PtC/PoPD-GOx in the absence of added background electrolyte (i.e., electropolymerization in unbuffered enzyme-monomer solution enhanced glucose selectivity 3-fold for this one-pot fabrication protocol which provided AA-rejection levels at least equal to recent multi-step polymer bilayer biosensor designs. Interestingly, the presence of enzyme protein in the polymer layer had opposite effects on permselectivity for low and high concentrations of AA, emphasizing the value of studying the concentration dependence of interference effects which is rarely reported in the literature.

  18. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care

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    Reach G

    2016-04-01

    Full Text Available Gérard Reach1,2 1Department of Endocrinology, Diabetes and Metabolic Diseases, Avicenne Hospital AP-HP, 2EA 3412, Centre de Recherche en Nutrition Humaine Ile-de-France (CRNH-IDF, Paris 13 University, Sorbonne Paris Cité, Bobigny, France Abstract: Patient education (PE is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient’s personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment. This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient–doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care. Keywords: patient education, adherence, autonomy, nudge, persuasion, manipulation, deception, trust, person-centered care model, shared decision-making

  19. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care.

    Science.gov (United States)

    Reach, Gérard

    2016-01-01

    Patient education (PE) is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient's personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment). This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient-doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care. PMID:27103791

  20. Patient education, nudge, and manipulation: defining the ethical conditions of the person-centered model of care

    Science.gov (United States)

    Reach, Gérard

    2016-01-01

    Patient education (PE) is expected to help patients with a chronic disease to manage their lives and give them the possibility of adopting, in an appropriate manner, beneficial changes in health behaviors that are prescribed by their physicians. It is aimed at delineating, agreeing on, and implementing a patient’s personal action plan and is therefore an essential constituent of the person-centered model of care. The aim of this article is to examine the idea that PE may sometimes be a manipulation that is organized for the good of patients in a paternalistic framework. Theoretically, PE differs from manipulation by addressing the reflective intelligence of patients in full light and helping them make autonomous choices. In this article, we examined some analogies between PE and nudge (ie, techniques used to push people to make good choices by organizing their environment). This analysis suggests that PE is not always as transparent and reflective as it is supposed to be and that unmasking these issues may be useful for improving the ethical quality of educational practice that must be performed in a framework of a trusting patient–doctor relationship. Under this condition, PE may sometimes represent a form of persuasion without being accused of patient deception and manipulation: trust is therefore the core of the person-centered model of care. PMID:27103791

  1. Visual acuity of fly photoreceptors in natural conditions - dependence on UV sensitizing pigment and light-controlling pupil

    NARCIS (Netherlands)

    Stavenga, DG

    2004-01-01

    The effect of the UV-absorbing sensitizing pigment fly photoreceptors on absolute, spectral and angular sensitivity was investigated with a wave-optics model for the facet lens-rhabdomere system. When sky light was used as a UV-rich light source, one sensitizing pigment molecule per rhodopsin increa

  2. Informing the development of services supporting self-care for severe, long term mental health conditions: a mixed method study of community based mental health initiatives in England

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    Steve Gillard

    2012-07-01

    Full Text Available Abstract Background Supporting self-care is being explored across health care systems internationally as an approach to improving care for long term conditions in the context of ageing populations and economic constraint. UK health policy advocates a range of approaches to supporting self-care, including the application of generic self-management type programmes across conditions. Within mental health, the scope of self-care remains poorly conceptualised and the existing evidence base for supporting self-care is correspondingly disparate. This paper aims to inform the development of support for self-care in mental health by considering how generic self-care policy guidance is implemented in the context of services supporting people with severe, long term mental health problems. Methods A mixed method study was undertaken comprising standardised psychosocial measures, questionnaires about health service use and qualitative interviews with 120 new referrals to three contrasting community based initiatives supporting self-care for severe, long term mental health problems, repeated nine months later. A framework approach was taken to qualitative analysis, an exploratory statistical analysis sought to identify possible associations between a range of independent variables and self-care outcomes, and a narrative synthesis brought these analyses together. Results Participants reported improvement in self-care outcomes (e.g. greater empowerment; less use of Accident and Emergency services. These changes were not associated with level of engagement with self-care support. Level of engagement was associated with positive collaboration with support staff. Qualitative data described the value of different models of supporting self-care and considered challenges. Synthesis of analyses suggested that timing support for self-care, giving service users control over when and how they accessed support, quality of service user-staff relationships and decision

  3. Modelling of the spent fuel dissolution rate evolution for repository conditions. Matrix Alteration Model results and sensitivity analysis

    International Nuclear Information System (INIS)

    This paper focuses on how to extrapolate current knowledge of spent fuel matrix alteration processes from laboratory to repository conditions, i.e., the influence of changes in both the environmental conditions and the range of time scale considered. Therefore, a spent fuel matrix alteration model allowing the alteration rate evolution to be predicted as a function of both the host rock considered and evaluation time scale of interest is described. At present, the model assumes that alteration of the spent fuel will start when the groundwater reaches the solid surface and that only the radiolytic species of the groundwater (oxidants generated by α-radiation of spent fuel) will produce the surface oxidation process and subsequent matrix dissolution; O2, H2O2 and OH- are the species that react with UO2(s) for oxidation of the pellet surface. The dissolution process of the surface sites that are oxidized is modelled in two steps: first, a surface co-ordination of the oxidized layer with aqueous ligands and, second, detachment (dissolution) of the product species. Taking this mechanism into account, the model gives the evolution of the spent fuel matrix alteration rate over periods as long as 1,000,000 years. In this work the matrix alteration rate results obtained for two repository environments, granitic and argillaceous, will be presented. Furthermore, a sensitivity analysis study has been performed on the influence of the following variables: type of spent fuel considered, α-dose rate evolution, α-range in groundwater, carbonate and iron concentration in groundwater, H2 partial pressure, container time failure and specific surface area of the pellet. (author)

  4. Comparison between superficial and solid-state cultures of Isaria fumosorosea: conidial yields, quality and sensitivity to oxidant conditions.

    Science.gov (United States)

    Muñiz-Paredes, Facundo; Garza-López, Paul Misael; Viniegra-González, Gustavo; Loera, Octavio

    2016-07-01

    Conidia production and quality from mycoinsecticides in solid-state cultures (SSC) are frequently inferred from superficial culture (SC) results. Both parameters were evaluated for two Isaria fumosorosea strains (ARSEF 3302 and CNRCB1), in SC and SSC, using culture media with the same chemical composition. For both strains, conidia production was higher in SC than SSC in terms of conidia per gram of dry substrate. Germination in both strains did not show significant differences between SC and SSC (>90 %). Similarly, conidia viability in ARSEF 3302 strain did not show differences at early stages between SC and SSC, but was higher in SC compared to SSC in the late stage of culture; in contrast, conidia from CNRCB1 strain did not differ between both culture systems. Some infectivity parameters improved in conidia from SSC, compared to SC at the early stages, but these differences disappeared at the final stage, independently of the strain. Both strains showed decreased conidia production when 26 % O2 pulses were applied; nevertheless, conidiation in SSC was two orders of magnitude more sensitive to oxidant pulses. In SC with 26 % O2 pulses, conidia viability for both strains at early stages, was higher than in normal atmospheric conditions. Infectivity towards Galleria mellonella larvae was similar between conidia from normal atmosphere and oxidant conditions; notably, for the strain ARSEF 3302 infectivity decreased at the final stage. This study shows the intrinsic differences between SC and SSC, which should be considered when using SC as a model to design production processes in SSC. PMID:27263006

  5. Sensitivity analysis and comparison of various potential evapotranspiration formulae for selected Greek areas with different climate conditions

    Science.gov (United States)

    Paparrizos, Spyridon; Maris, Fotios; Matzarakis, Andreas

    2016-01-01

    Potential evapotranspiration (PET) is one of the most critical parameters in the research on agro-ecological systems. The computational methods for the estimation of PET vary in data demands from very simple (empirically based), requiring only information based on air temperatures, to complex ones (more physically based) that require data on radiation, relative humidity, wind speed, etc. The current research is focused on three study areas in Greece that face different climatic conditions due to their location. Twelve PET formulae were used, analyzed and inter-compared in terms of their sensitivity regarding their input coefficients for the Ardas River basin in north-eastern Greece, Sperchios River basin in Central Greece and Geropotamos River basin in South Greece. The aim was to compare all the methods and conclude to which empirical PET method(s) better represent the PET results in each area and thus should be adopted and used each time and which factors influence the results in each case. The results indicated that for the areas that face Mediterranean climatic conditions, the most appropriate method for the estimation of PET was the temperature-based, Hamon's second version (PETHam2). Furthermore, the PETHam2 was able to estimate PET almost similarly to the average results of the 12 equations. For the Ardas River basin, the results indicated that both PETHam2 and PETHam1 can be used to estimate PET satisfactorily. Moreover, the temperature-based equations have proven to produce better results, followed by the radiation-based equations. Finally, PETASCE, which is the most commonly used PET equation, can also be applied occasionally in order to provide satisfactory results.

  6. Trends in long-term opioid prescribing in primary care patients with musculoskeletal conditions: an observational database study.

    Science.gov (United States)

    Bedson, John; Chen, Ying; Hayward, Richard A; Ashworth, Julie; Walters, Kate; Dunn, Kate M; Jordan, Kelvin P

    2016-07-01

    Long-term opioids may benefit patients with chronic pain but have also been linked to harmful outcomes. In the United Kingdom, the predominant source of opioids is primary care prescription. The objective was to examine changes in the incidence, length, and opioid potency of long-term prescribing episodes for musculoskeletal conditions in UK primary care (2002-2013). This was an observational database study (Clinical Practice Research Datalink, 190 practices). Participants (≥18 years) were prescribed an opioid for a musculoskeletal condition (no opioid prescribed in previous 6 months), and issued ≥2 opioid prescriptions within 90 days (long-term episode). Opioids were divided into short- and long-acting noncontrolled and controlled drugs. Annual incidence of long-term opioid episodes was determined, and for those still in a long-term episode, the percentage of patients prescribed each type 1 to 2 years, and >2 years after initiation. Annual denominator population varied from 1.25 to 1.38 m. A total of 76,416 patients started 1 long-term episode. Annual long-term episode incidence increased (2002-2009) by 38% (42.4-58.3 per 10,000 person-years), remaining stable to 2011, then decreasing slightly to 55.8/10,000 (2013). Patients prescribed long-acting controlled opioids within the first 90 days of long-term use increased from 2002 to 2013 (2.3%-9.9%). In those still in a long-term opioid episode (>2 years), long-acting controlled opioid prescribing increased from 3.5% to 22.6%. This study has uniquely shown an increase in prescribing long-term opioids to 2009, gradually decreasing from 2011 in the United Kingdom. The trend was towards increased prescribing of controlled long-acting opioids and earlier use. Further research into the risks and benefits of opioids is required. PMID:27003191

  7. Antibiotic sensitivity profile of bacterial pathogens in postoperative wound infections at a tertiary care hospital in Gujarat, India

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    Nutanbala N Goswami

    2011-01-01

    Full Text Available Objective: To find out the most common bacterial pathogens responsible for post-operative wound infection and their antibiotic sensitivity profile. Materials and Methods: This prospective, observational study was carried out in patients of postoperative wound infection. Samples from wound discharge were collected using a sterile swab and studied for identification of isolates by Gram stains and culture growth followed by in vitro antibiotic susceptibility testing performed by disc diffusion method on Mueller Hinton agar. Results: Out of 183 organisms, 126 (68.85% isolated organisms were gram negative. Staphylococcus aureus, 48 (26.23%, was the predominant organism. S. aureus was sensitive to rifampicin (89.58%, levofloxacin (60.42%, and vancomycin (54.17%. Pseudomonas aeruginosa was sensitive to ciprofloxacin (83.78%, gatifloxacin (51.35%, and meropenem (51.35%. Escherichia coli was sensitive to levofloxacin (72.41% and ciprofloxacin (62.07%. Klebsiella pneumoniae was sensitive to ciprofloxacin (63.16%, levofloxacin (63.16%, gatifloxacin (63.16%, and linezolid (56.52%. Proteus mirabilis was sensitive to ciprofloxacin (75% and linezolid (62.50. Proteus vulgaris was sensitive to ampicillin+sulbactam (57.14% followed by levofloxacin (50%. Conclusions: There is an alarming increase of infections caused by antibiotic-resistant bacteria, particularly in the emergence of VRSA/VISA, meropenem, and third generation cephalosporin resistant Pseudomonas aeruginosa. Linezolid showing sensitivity against Gram negative bacteria.

  8. Myocardial performance index is sensitive to changes in cardiac contractility, but is also affected by vascular load condition.

    Science.gov (United States)

    Uemura, Kazunori; Kawada, Toru; Zheng, Can; Li, Meihua; Shishido, Toshiaki; Sugimachi, Masaru

    2013-01-01

    Myocardial performance index (MPI), or Tei index, is measured by Doppler echocardiography in clinical practice. MPI has been shown to be useful in evaluating left ventricular (LV) performance and predicting prognosis in cardiac patients. However, the effects of LV load and contractile states on MPI remain to be thoroughly investigated. In 14 anesthetized dogs, we obtained LV pressure-volume relationship with use of sonomicrometry and catheter-tip manometry. MPI was determined from the time derivative of LV volume and pressure. LV end-systolic pressure-volume ratio (Ees'), effective arterial elastance (Ea) and LV end-diastolic volume (Ved) were used as indices of LV contractility, afterload and preload, respectively. Hemodynamic conditions were varied over wide ranges [heart rate (HR), 66-192 bpm; mean arterial pressure, 71-177 mmHg] by infusing cardiovascular agents, by inducing ischemic heart failure and by electrical atrial pacing. Multiple linear regression analysis of pooled data (66 data sets) indicated that MPI (0.6-1.8) significantly correlated with Ees' [1.5-17.5 mmHg · ml(-1), pVed (11-100 ml, p0.1). Theoretical analysis also indicated that MPI decreases following the increases in LV contractility and in preload, while it increases in response to an increase in LV afterload. We conclude that MPI sensitively detects changes in LV contractility. However, MPI is also affected by changes in LV afterload and preload. PMID:24109782

  9. Chromosomal Conditions

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Ask ...

  10. Teams and working conditions in mobile pre-hospital care services: an integrative review

    Directory of Open Access Journals (Sweden)

    Daiane Dal Pai

    2015-12-01

    Full Text Available Study to identify, analyze and summarize the findings available in the literature on the composition of teams and working conditions in Mobile  Pre-Hospital Care Services  (PHC.  Integrative review to search the Base  de Dados  de  Enfermagem [Nursing Database] (BDEnf, the Cumulative  Index  to  Nursing  and  Allied  Health  Literature (CINAHL,  the Latin American and Caribbean Health Sciences Literature (LILACS, PubMed,  SCOPUS,  Web  of  Science and the portal of journals from the Scientific  Electronic  Library Online  (SciELO. Eighteen articles met the inclusion criteria and were selected. The composition of the teams for PHC services is diversified on the international stage, with the increase in responsibilities assumed by paramedics and the benefits of the specialized nurse's and doctor's presence in the teams being portrayed, which are scarce in some countries.  Working conditions reveal risky places of work, intense psychological demands, work overload, dissatisfaction and inadequate resources in most services.

  11. Antibiotic sensitivity pattern of gram negative bacilli isolated from the lower respiratory tract of ventilated patients in the intensive care unit

    Directory of Open Access Journals (Sweden)

    Goel Nidhi

    2009-01-01

    Full Text Available Background: Lower respiratory tract infections (LRTIs are the most frequent infections among patients in Intensive care units (ICUs. Aims: To know the bacterial profile and determine the antibiotic susceptibility pattern of the lower respiratory tract isolates from patients admitted to the ICU. Settings and Design: Tertiary care hospital, retrospective study. Materials and Methods: Transtracheal or bronchial aspirates from 207 patients admitted to the ICU were cultured, identified, and antibiotic sensitivity was performed by standard methods. Statistical Analysis Used: SPSS software was used for calculation of % R of 95% confidence interval (CI. Results: Of 207 specimens, 144 (69.5% were culture positive and 63 (30.4% showed no growth. From 144 culture positives, 161 isolates were recovered, of which 154 (95.6% were Gram negative bacilli (GNB. In 17 (11.0% patients, two isolates per specimen were recovered. The most common GNB in order of frequency were Pseudomonas aeruginosa (35%, Acinetobacter baumannii (23.6%, and Klebsiella pneumoniae (13.6%. A very high rate of resistance (80-100% was observed among predominant GNB to ciprofloxacin, ceftazidime, co-trimoxazole, and amoxycillin/clavulanic acid combination. Least resistance was noted to meropenem and doxycycline. Conclusion: Nonfermenters are the most common etiological agents of LRTIs in ICU. There is an alarmingly high rate of resistance to cephalosporin and β-lactam-β-lactamase inhibitor group of drugs. Meropenem was found to be the most sensitive drug against all GNB. Acinetobacter and Klebsiella spp. showed good sensitivity to doxycycline.

  12. Life history trade-offs and behavioral sensitivity to testosterone: an experimental test when female aggression and maternal care co-occur.

    Directory of Open Access Journals (Sweden)

    Kimberly A Rosvall

    Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.

  13. The impact of chronic conditions of care recipients on the labour force participation of informal carers in Australia: which conditions are associated with higher rates of non-participation in the labour force?

    OpenAIRE

    Schofield, Deborah; Cunich, Michelle; Shrestha, Rupendra; Passey, Megan; Kelly, Simon; Tanton, Robert; Veerman, Lennert

    2014-01-01

    Background Little is known about the effects of personal and other characteristics of care recipients on the behaviour of carers. The aim of this study is to examine the association between the main chronic (disabling) condition of care recipients and the likelihood of their (matched) primary carers aged 15–64 years being out of the labour force. Methods We conducted a retrospective analysis of cross-sectional data from the Australian Bureau of Statistics 2009 Survey of Disability, Ageing and...

  14. Two-warehouse inventory model for deteriorating items with price-sensitive demand and partially backlogged shortages under inflationary conditions

    Directory of Open Access Journals (Sweden)

    Chandra K. Jaggi

    2015-01-01

    Full Text Available In today’s competition inherited business world, managing inventory of goods is a major challenge in all the sectors of economy. The demand of an item plays a significant role while managing the stock of goods, as it may depend on several factors viz., inflation, selling price, advertisement, etc. Among these, selling price of an item is a decisive factor for the organization; because in this competitive world of business one is constantly on the lookout for the ways to beat the competition. It is a well-known accepted fact that keeping a reasonable price helps in attracting more customers, which in turn increases the aggregate demand. Thus in order to improve efficiency of business performance organization needs to stock a higher inventory, which needs an additional storage space. Moreover, in today’s unstable global economy there is consequent decline in the real value of money, because the general level of prices of goods and services is rising (i.e., inflation. And since inventories represent a considerable investment for every organization, it is inevitable to consider the effects of inflation and time value of money while determining the optimal inventory policy. With this motivation, this paper is aimed at developing a two-warehouse inventory model for deteriorating items where the demand rate is a decreasing function of the selling price under inflationary conditions. In addition, shortages are allowed and partially backlogged, and the backlogging rate has been considered as an exponentially decreasing function of the waiting time. The model jointly optimizes the initial inventory and the price for the product, so as to maximize the total average profit. Finally, the model is analysed and validated with the help of numerical examples, and a comprehensive sensitivity analysis has been performed which provides some important managerial implications.

  15. Divergence of gut permeability and mucosal immune gene expression in two gluten-associated conditions: celiac disease and gluten sensitivity

    Directory of Open Access Journals (Sweden)

    Esposito Pasquale

    2011-03-01

    Full Text Available Abstract Background Celiac disease (CD is an autoimmune enteropathy triggered by the ingestion of gluten. Gluten-sensitive individuals (GS cannot tolerate gluten and may develop gastrointestinal symptoms similar to those in CD, but the overall clinical picture is generally less severe and is not accompanied by the concurrence of tissue transglutaminase autoantibodies or autoimmune comorbidities. By studying and comparing mucosal expression of genes associated with intestinal barrier function, as well as innate and adaptive immunity in CD compared with GS, we sought to better understand the similarities and differences between these two gluten-associated disorders. Methods CD, GS and healthy, gluten-tolerant individuals were enrolled in this study. Intestinal permeability was evaluated using a lactulose and mannitol probe, and mucosal biopsy specimens were collected to study the expression of genes involved in barrier function and immunity. Results Unlike CD, GS is not associated with increased intestinal permeability. In fact, this was significantly reduced in GS compared with controls (P = 0.0308, paralleled by significantly increased expression of claudin (CLDN 4 (P = 0.0286. Relative to controls, adaptive immunity markers interleukin (IL-6 (P = 0.0124 and IL-21 (P = 0.0572 were expressed at higher levels in CD but not in GS, while expression of the innate immunity marker Toll-like receptor (TLR 2 was increased in GS but not in CD (P = 0.0295. Finally, expression of the T-regulatory cell marker FOXP3 was significantly reduced in GS relative to controls (P = 0.0325 and CD patients (P = 0.0293. Conclusions This study shows that the two gluten-associated disorders, CD and GS, are different clinical entities, and it contributes to the characterization of GS as a condition associated with prevalent gluten-induced activation of innate, rather than adaptive, immune responses in the absence of detectable changes in mucosal barrier function.

  16. Investigating and Addressing Barriers to the Effective Recognition and Management of Depression in People with Long-term Conditions in Primary Care

    OpenAIRE

    Karachaliou, Dimitra

    2016-01-01

    Objectives: Depression is often unrecognised or sub-optimally treated in primary care. This has led to research exploring the barriers and enablers to effective recognition but little is known about health care professionals’ (HCPs) beliefs or personal illness models about depression in patients with long term conditions (LTCs), the presence of which may affect recognition and management. Using Leventhal’s Common Sense or Self-regulatory Model this thesis aimed to: explore HCPs’ illness repre...

  17. Influence of external and internal conditions of detector sample treatment on the particle registration sensitivity of Solid State Nuclear Track Detectors of type CR-39

    International Nuclear Information System (INIS)

    The sensitivity of charged particle registration with SSNTD is the most important parameter to decide about the applicability of those detectors in research, technology and environmental dosimetry. The sensitivity is strongly influenced by the treatment of detector samples before, during and after the exposure and the final evaluation process by chemical etching. Whereas changes in detection properties by external environmental influences are generally considered, the dependences on the etching conditions are ignored. Commonly the sensitivity is assumed to compensate variations in the etching conditions for track revealing. In the present work the validity of this hypothesis will be checked. In the frame of the existing database the sensitivity is not really independent on variations in etching temperatures and should be corrected for differences in the activation energies for stimulation of the bulk and track etching process. Differences in the concentration dependence may be of minor importance. Furthermore, the registration sensitivity depends on environmental conditions before, during and after the irradiation with particles under investigation. Such external parameters are the air pressure, the sample temperature and modification of bulk material by out-gassing in vacuum and exposure to γ-rays. However, the available database is insufficient and inaccurate to draw final conclusions on the detection properties of SSNTD under various external and internal conditions.

  18. Attitudes of livestock farmers and sensitivity of livestock farming systems to drought conditions in the French Alps

    Directory of Open Access Journals (Sweden)

    Laurent Dobremez

    2011-01-01

    Full Text Available Livestock farming systems in the French Alps are particularly exposed to the predicted climate change and most of them have already experienced periods of drought since the beginning of the 2000s. Faced with this risk, livestock farmers have put in place a certain number of measures and envisage introducing others in the future. For the present study, surveys were conducted among livestock farmers to identify these measures and analyses were carried out to characterise the attitudes of livestock farmers to drought conditions and to evaluate changes in the sensitivity of their livestock farming systems. With the exception of those farms with extensive irrigated areas, all the farms are seeking solutions to deal with the risks arising from droughts. One solution is to purchase fodder to compensate for the decrease in the harvests that normally provide animal feed in the winter; the amounts purchased vary with the length of wintering required. For the grazing periods, the high mountain livestock breeders and the dairy systems of the Northern Alps rely above all on extending and over-sizing the pasture areas in relation to the needs of the herds. The livestock farms of the Southern Alps also rely on the diversity of vegetation areas and a certain flexibility in the practices used to adapt to conditions experienced during the year. A succession of dry years could result in more radical breakdowns in the livestock systems. It should also be remembered that climate change is only one of the factors influencing the types of changes taking place on farms.Les systèmes d'élevage des Alpes françaises sont fortement exposés au changement climatique annoncé et la plupart subissent déjà des épisodes de sécheresse depuis le début des années 2000. Face à ces aléas, les éleveurs ont mis en œuvre un certain nombre de leviers et envisagent d'en activer d'autres à l'avenir. Des enquêtes en exploitation ont permis d’identifier ces leviers. Leur

  19. Garde a l'enfance: Etude sur la remuneration et les conditions de travail dans le domaine de la garde a l'enfance au Canada. Rapport final (Caring for a Living: A Study on Wages and Working Conditions in Canadian Child Care. Final Report).

    Science.gov (United States)

    Canadian Child Care Federation, Ottawa (Ontario).

    Between November 1990 and August 1992, a study examined wages and working conditions of child care staff in both licensed group centers and family day care homes in Canada. Three instruments were developed for the study, a short telephone interview for center directors, a follow-up director's questionnaire, and a staff questionnaire. The study…

  20. Pattern of pathogens and their sensitivity isolated from superficial surgical site infections in a tertiary care hospital

    International Nuclear Information System (INIS)

    Infection is an important cause of morbidity and mortality in surgical patients. Rapidly emerging nosocomial pathogens and the problem of multi-drug resistance necessitates periodic review of isolation patterns and sensitivity in surgical practice. Surgical site infections (SSI) are defined as an infections that occurs at the incision site within thirty days after surgery. Objectives of the study were to determine the pattern of pathogens involved and their antibiotic sensitivity isolated from superficial surgical site infections in a teaching hospital. This observational study was conducted for 1 year from January 2008 to December 2008 in all 4 surgical units of Liaquat University Hospital Hyderabad which caters to patients from low socioeconomic status. Pus culture and sensitivity reports were collected prospectively from hospitalised patients who developed postoperative wound infection. The patients who developed fecal/biliary/urinary fistula or operated for malignancies, and with negative cultures were excluded from the study. Analysis was carried out using SPSS 10. During the study period 112 pus culture and sensitivity reports were analyzed. E. coli 68 (60.7%) was the most common organism isolated followed by Klebsiella 23 (20.5%). The least frequent organism was staph. Epidermidis 1 (0.9%). All isolates were sensitive to penicillin derivatives and carbapenem. Quinolones, Aminoglycosides and Monobactum were also showing some promise in our study. However, Cephalosporins were ineffective against most of the important isolates in our study. E. coli and klebsiella were the most important isolates form SSI in our study, and penicillin derivatives and carbapenem were showing 100% antibiotic sensitivity to all of the isolates. (author)

  1. Sensitivity and specificity of a rapid point-of-care test for active yaws: a comparative study

    OpenAIRE

    Telek Ayove, BSc; Wendy Houniei, HEO; Regina Wangnapi, MBBS; Sibauk V Bieb, MBBS; Walter Kazadi, MD; Lisol-Nirau Luke, BSc; Clement Manineng, MBBS; Penias Moses, HEO; Raymond Paru, BSc; Javan Esfandiari, MSc; Prof. Pedro L Alonso, MD; Elisa de Lazzari, MSc; Quique Bassat, MD; Prof. David Mabey, MD; Dr. Oriol Mitjà, MD

    2014-01-01

    Background: To eradicate yaws, national control programmes use the Morges strategy (initial mass treatment and biannual resurveys). The resurvey component is designed to actively detect and treat remaining yaws cases and is initiated on the basis of laboratory-supported reactive non-treponemal serology (using the rapid plasma reagin [RPR] test). Unfortunately, the RPR test is available rarely in yaws-endemic areas. We sought to assess a new point-of-care assay—the Dual Path Platform (DPP) syp...

  2. Evaluation of the strengthening of the conditions of voltage security using sensitivity analysis; Avaliacao do reforco das condicoes da seguranca de tensao utilizando a analise de sensibilidade

    Energy Technology Data Exchange (ETDEWEB)

    Rosa, A.L.S.; Costa, V.M. da; Peres, W. [Universidade Federal de Juiz de Fora (UFJF), MG (Brazil). Faculdade de Engenharia], Emails: arleilucas@gmail.com, vander@lacee.ufjf.br, wesley.peres@yahoo.com.br; Prada, R.B. [Pontificia Universidade Catolica (PUC-Rio), Rio de Janeiro, RJ (Brazil). Dept. de Engenharia Eletrica], Email: prada@ele.puc-rio.br

    2009-07-01

    Voltage stability or voltage security analysis has motivated an expressive attention of power systems researchers. In this work, a simple and fast method evaluates voltage security and proposes conditions to improve the loading margin. System analysis is carried out in terms of active power transmission path. Sensitivity analysis provides the most adequate buses to active and reactive power redispatch. A sequential iterative methodology to reinforce system conditions is presented. (author)

  3. CURRENT SENSITIVITY PATTERN OF MRSA (METHICILLIN RESISTANT STAPH AUREUS IN A TERTIARY CARE ORTHOPAEDIC HOSPITAL IN KASHMIR (J&K

    Directory of Open Access Journals (Sweden)

    Shaika

    2016-02-01

    Full Text Available In view of the reported emergence of vancomycin resistance in MRSA from the state and the country as a whole we evaluated the pattern of culture and sensitivity on 160 samples from Orthopaedic Department over a period of one year between Nov 2014 and Nov 2015. These belonged to 111 males and 49 females with different aetiologies. Using standard protocols for the culture, 84 (52% samples grew no organisms while Staph aureus was grown in 43 samples (26.8% and gram negative organism in 28 and 5 samples grew mixed organism. Out of these 43 isolates of Staph aureus, MRSA was grown in 32 (74.4% and MSSA in 11 (25.6%. These belonged to 23 (71.8% males and 9 (28.1% females. Majority of MRSA were grown from the patients of acute osteomyelitis and operated fractures (63.3%. Linezolid showed highest sensitivity (100% followed by Vancomycin (96.8%, Clindamycin (37.5%, erythromycin (21%, Amikacin (21%, Levofloxacin (9.3%, cotrimoxazole (9.3% and ciprofloxacin (3.1%. By diffusion method 6 positive cultures depicted doubtful sensitivity pattern for vancomycin (18.75%. However, on further analysis using MIC only one isolate (3.3% showed intermediate resistance to vancomycin; 12 cultures (37.5% were sensitive to vancomycin and linezolid only. The presence of vancomycin resistance calls for a watchful approach towards these infections and an extensive study to better define the problem.

  4. Synthesis analysis of the temperature sensitivity of soil respiration from laboratory studies in relation to incubation methods and soil conditions

    OpenAIRE

    Hamdi, S.; Moyano, F.; Sall, S.; Bernoux, Martial; Chevallier, Tiphaine

    2013-01-01

    The temperature sensitivity of soil respiration is a main factor determining the response of global terrestrial soil carbon to global warming and, consequently, its feedback on atmospheric CO2 concentrations. A data synthesis was performed to summarize information available in the literature on the temperature sensitivity of soil respiration obtained in laboratory soil incubations and expressed as Q(10). The influence of common experimental variables and methods, i.e. range of incubation temp...

  5. Quality of care assessment in geriatric evaluation and management units: construction of a chart review tool for a tracer condition

    OpenAIRE

    Latour Judith; Leduc Nicole; Leclerc Bernard-Simon; Kergoat Marie-Jeanne; Berg Katherine; Bolduc Aline

    2009-01-01

    Abstract Background The number of elderly people requiring hospital care is growing, so, quality and assessment of care for elders are emerging and complex areas of research. Very few validated and reliable instruments exist for the assessment of quality of acute care in this field. This study's objective was to create such a tool for Geriatric Evaluation and Management Units (GEMUs). Methods The methodology involved a reliability and feasibility study of a retrospective chart review on 934 o...

  6. A Coupled MM5-Noah Land Surface Model-based assessment of Sensitivity of Planetary Boundary Variables to Anomalous Soil Moisture Conditions

    Science.gov (United States)

    The sensitivity of near-surface weather variables and small-scale convection to soil moisture for Western Kentucky was investigated with the aid of the Penn State/NCAR mesoscale atmospheric model MM5 for three different synoptic conditions during June 2006. The model was initialized with FNL reanaly...

  7. Evaluation of the sensitivity of RT-23 purified protein derivative for determining tuberculin reactivity in a group of health care workers.

    Science.gov (United States)

    Molina-Gamboa, J D; Ponce-de-León-Rosales, S; Rivera-Morales, I; Romero, C; Báez, R; Huertas, M; Osornio, G

    1994-10-01

    Since 1958 the World Health Organization (WHO) has recommended the use of RT-23 (2 tuberculin unit [TU] purified protein derivative [PPD]) instead of the standard 5 TU PPD to establish the prevalence of tuberculosis (TB) around the world. Before starting a hospital program to control the transmission of TB among health care workers at the National Institute of Nutrition (Mexico City), we compared the tuberculin product commonly used in Mexico (RT-23) with that used in the United States (5 TU PPD). In this trial the Mantoux test was performed on 80 health care workers from various areas of the hospital: 5 TU PPD and RT-23 were simultaneously inoculated in the left forearm and in the right forearm, respectively. The test results for both tuberculin products were read 72 hours later. When a 10-mm induration was used as the cutoff for reactivity, the specificity with use of RT-23 was 100%, but the sensitivity was only 57%. However, when a 5-mm induration was used as the cutoff, the sensitivity with use of RT-23 was 90%. Because of these findings, we advise that every country using RT-23 either consider changing the cutoff for reactivity or consider using 5 TU PPD for reassessment of the data on the incidence and prevalence of TB that were obtained with use of RT-23 (the product recommended by WHO). PMID:7803652

  8. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

    OpenAIRE

    Kapadia Dharmi; Reeves David; Blickem Christian; Bower Peter; Protheroe Joanne; Kennedy Anne; Chew-Graham Carolyn; Kirk Susan; Sanders Caroline; Vassilev Ivaylo; Rogers Anne; Brooks Helen; Fullwood Catherine; Richardson Gerry

    2011-01-01

    Abstract Background Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing...

  9. Access to Services, Quality of Care, and Family Impact for Children with Autism, Other Developmental Disabilities, and Other Mental Health Conditions

    Science.gov (United States)

    Vohra, Rini; Madhavan, Suresh; Sambamoorthi, Usha; St Peter, Claire

    2014-01-01

    This cross-sectional study examined perceived access to services, quality of care, and family impact reported by caregivers of children aged 3-17 years with autism spectrum disorders, as compared to caregivers of children with other developmental disabilities and other mental health conditions. The 2009-2010 National Survey of Children with…

  10. THERAPEUTIC PROCEDURES OF CHILDREN WITH DISHARMONIOUS DEVELOPMENT AT THE EARLY SCHOOL PERIOD IN CONDITIONS OF DAY CARE HOSPITAL

    Directory of Open Access Journals (Sweden)

    Dragoslav KOPACEV

    1997-12-01

    Full Text Available The term disharmonious is determined against the harmonious development of children. It is stressed that these children, because of the whole bio-psycho-social growth which is at a lower level, very often react with psychical disorders, compared with the children which normally develop and this seems to be not only a serious problem in the diagnostics but also in the performing of the adequate and in due time treatment.Trained by the existing experiences in the work with these children it is indicated that the best differential-diagnostics is performed in conditions of Day hospital where a whole treatment is provided by a professional team. In the treatment in this category of children it is insisted on the respect of the developmental dynamic approach, and for this, the acknowledgments that are given by the neuropsychology are used. The need of early treatment of a child, parents and the closest environment is stressed because if these children are neglected, they show the tendency to organize themselves at their lowest values, they intellectually decline and lead to severe psycho social results .Working with these children in our Day care hospital although we use a great number of therapeutic activities, we put the stress on the application of psycho-motor re education. The use of remedial therapy is the only technical, without including the parents in the working plan, has shown as unadequate. Although there is an intellectual insufficiency, we tend these children to be mentally healthy, if we succeed to achieve bigger harmony in the function of the cognitive, emotional, motor and social aspects of the individual. Providing continuity in the treatment of this category of children, it is insisted to provide the preschool institutions with planned and professional team work. The stress is put on the defectological activity, in a way to prepare the children to enroll in school.

  11. Pavlovian conditioning and cross-sensitization studies raise challenges to the hypothesis that overeating is an addictive behavior

    OpenAIRE

    Harb, M.; De Almeida, O.

    2014-01-01

    Elevated glucocorticoid levels and sign tracking (ST) in Pavlovian conditioning are potential biomarkers of compulsive behaviors such as addiction. As overeating is sometimes viewed as a form of addictive behavior, we hypothesized that murine Pavlovian sign trackers would have a greater propensity to overeat and develop obesity. Using a food reward in the classical conditioning paradigm, we show that ST behavior is a robust conditioned response but not a predictor of eating and growth traject...

  12. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

    OpenAIRE

    Reuven Rasooly; Hugh Alan Bruck; Joshua Balsam; Ben Prickril; Miguel Ossandon; Avraham Rasooly

    2016-01-01

    Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for u...

  13. Caring for Multiples

    Science.gov (United States)

    ... labor & premature birth The newborn intensive care unit (NICU) Birth defects & other health conditions Loss & grief Tools & ... Home > Complications & Loss > The newborn intensive care unit (NICU) > Caring for multiples Caring for multiples E-mail ...

  14. A sensitive chemiluminescent immunoassay for point-of-care testing of repaglinide in natural dietary supplements and serum.

    Science.gov (United States)

    Zheng, Lei; Wang, Jing; Wang, Yufen; Song, Zhaorui; Dong, Yaqing; Yin, Yongmei; Eremin, Sergei A; Meng, Meng; Xi, Rimo

    2015-03-01

    For point-of-care testing of the illegal fortification of repaglinide (Rep) in natural dietary supplements, a competitive chemiluminescent immunoassay (CLIA) was established, using a horseradish peroxidase (HRP)-luminol-H2O2 system for signal amplification. Polyclonal antibodies for Rep were produced via immunization technique. Following optimization of the enzyme reaction time and concentrations of antibody and coating antigen, the method showed a limit of quantification (LOQ) of 1.0 ng/mL in PBS and limit of detection (LOD) of 8.3 ng/mL in serum and 6.0 ng/mL in blank tablets. When applied in natural dietary supplements, the method provided results consistent with those from HPLC, suggesting that the proposed method could be used for rapid screening of Rep in natural dietary supplements and detecting Rep in serum after administration. PMID:25656849

  15. Social networks, work and network-based resources for the management of long-term conditions: a framework and study protocol for developing self-care support

    Directory of Open Access Journals (Sweden)

    Kapadia Dharmi

    2011-05-01

    Full Text Available Abstract Background Increasing the effective targeting and promotion of self-care support for long-term conditions requires more of a focus on patient contexts and networks. The aim of this paper is to describe how within a programme of research and implementation, social networks are viewed as being centrally involved in the mobilisation and deployment of resources in the management of a chronic condition. This forms the basis of a novel approach to understanding, designing, and implementing new forms of self-management support. Methods Drawing on evidence syntheses about social networks and capital and the role of information in self-management, we build on four conceptual approaches to inform the design of our research on the implementation of self-care support for people with long-term conditions. Our approach takes into consideration the form and content of social networks, notions of chronic illness work, normalisation process theory (NPT, and the whole systems informing self-management engagement (WISE approach to self-care support. Discussion The translation and implementation of a self-care agenda in contemporary health and social context needs to acknowledge and incorporate the resources and networks operating in patients' domestic and social environments and everyday lives. The latter compliments the focus on healthcare settings for developing and delivering self-care support by viewing communities and networks, as well as people suffering from long-term conditions, as a key means of support for managing long-term conditions. By focusing on patient work and social-network provision, our aim is to open up a second frontier in implementation research, to translate knowledge into better chronic illness management, and to shift the emphasis towards support that takes place outside formal health services.

  16. Effect of temperature on the galvanic corrosion of a duplex stainless steel in its sensitized and un-sensitized condition in 992 g/L aqueous LiBr solution

    International Nuclear Information System (INIS)

    Duplex stainless steels have two phases (ferrite and austenite in balanced percentage). When duplex stainless steels are subjected to a heat treatment, they undergo morphological changes like the formation of new phases or the austenite/ferrite ratio variation. This work analyzes the influence of these morphological changes on the galvanic corrosion when the un-sensitized duplex - sensitized duplex pair is in contact with 992 g/L aqueous lithium bromide solution at different temperatures (25 C, 50 C, and 75 C). In order to obtain a sensitized sample, the duplex stainless steel was heat treated at 825 C in an inert atmosphere for 1 hour. Sensitized samples were studied by means of scanning electron microscopy (SEM), backscattering electrons, and Energy dispersive X-ray analysis (EDX). Galvanic corrosion was studied under open circuit conditions using a zero-resistance ammeter (ZRA). Cyclic potentiodynamic curves were also determined using a SOLARTRON 1287 potentio-stat. The mixed potential and the galvanic current density can be estimated by superimposing the anodic branch of the less noble material to the cathodic branch of the noblest material. Mixed potential values increase with temperature, and the results show that the active material is the un-sensitized sample and the noblest material is the sensitized sample. This trend increases with temperature. Furthermore, the results obtained by means of the ZRA technique show that the active material is the un-sensitized sample. The mean galvanic potential increases with exposure time and solution temperature and the mean galvanic current density decreases with temperature. (authors)

  17. Do we care about sustainability? An analysis of time sensitivity of social preferences under environmental time-persistent effects.

    Science.gov (United States)

    Faccioli, Michela; Hanley, Nick; Torres, Cati; Font, Antoni Riera

    2016-07-15

    Environmental cost-benefit analysis has traditionally assumed that the value of benefits is sensitive to their timing and that outcomes are valued higher, the sooner in time they occur following implementation of a project or policy. Though, this assumption might have important implications especially for the social desirability of interventions aiming at counteracting time-persistent environmental problems, whose impacts occur in the long- and very long-term, respectively involving the present and future generations. This study analyzes the time sensitivity of social preferences for preservation policies of adaptation to climate change stresses. Results show that stated preferences are time insensitive, due to sustainability issues: individuals show insignificant differences in benefits they can experience within their own lifetimes compared to those which occur in the longer term, and which will instead be enjoyed by future generations. Whilst these results may be specific to the experimental design employed here, they do raise interesting questions regarding choices over time-persistent environmental problems, particularly in terms of the desirability of interventions which produce longer-term benefits. PMID:27123670

  18. Identifying organisational principles and management practices important to the quality of health care services for chronic conditions

    DEFF Research Database (Denmark)

    Frølich, Anne

    2012-01-01

    which management practices in the CCM are most efficient and in what combinations. In addition, financial incentives and public reporting of performance are often considered effective at improving the quality of health care services, but this has not yet been definitively proved.......The quality of health care services offered to people suffering from chronic diseases often fails to meet standards in Denmark or internationally. The population consisting of people with chronic diseases is large and accounts for about 70% of total health care expenses. Given that resources are...

  19. Psychometric properties of the patient assessment of chronic illness care measure: acceptability, reliability and validity in United Kingdom patients with long-term conditions

    Directory of Open Access Journals (Sweden)

    Rick Jo

    2012-08-01

    Full Text Available Abstract Background The Patient Assessment of Chronic Illness Care (PACIC is a US measure of chronic illness quality of care, based on the influential Chronic Care Model (CCM. It measures a number of aspects of care, including patient activation; delivery system design and decision support; goal setting and tailoring; problem-solving and contextual counselling; follow-up and coordination. Although there is developing evidence of the utility of the scale, there is little evidence about its performance in the United Kingdom (UK. We present preliminary data on the psychometric performance of the PACIC in a large sample of UK patients with long-term conditions. Method We collected PACIC, demographic, clinical and quality of care data from patients with long-term conditions across 38 general practices, as part of a wider longitudinal study. We assess rates of missing data, present descriptive and distributional data, assess internal consistency, and test validity through confirmatory factor analysis, and through associations between PACIC scores, patient characteristics and related measures. Results There was evidence that rates of missing data were high on PACIC (9.6% - 15.9%, and higher than on other scales used in the same survey. Most PACIC sub-scales showed reasonable levels of internal consistency (alpha = 0.68 – 0.94, responses did not demonstrate high skewness levels, and floor effects were more frequent (up to 30.4% on the follow up and co-ordination subscale than ceiling effects (generally Conclusion The importance of improving care for long-term conditions means that the development and validation of measures is a priority. The PACIC scale has demonstrated potential utility in this regard, but further assessment is required to assess low levels of completion of the scale, and to explore the performance of the scale in predicting outcomes and assessing the effects of interventions.

  20. Conditional Estimation of Sensitivity and Specificity from a Phase 2 Biomarker Study Allowing Early Termination for Futility

    OpenAIRE

    Pepe, Margaret Sullivan; Feng, Ziding; Longton, Gary; Koopmeiners, Joseph

    2009-01-01

    Development of a disease screening biomarker involves several phases. In phase 2 its sensitivity and specificity is compared with established thresholds for minimally acceptable performance. Since we anticipate that most candidate markers will not prove to be useful and availability of specimens and funding is limited, early termination of a study is appropriate if accumulating data indicate that the marker is inadequate. Yet, for markers that complete phase 2, we seek estimates of sensitivit...

  1. Evaluation of IGBT thermo-sensitive electrical parameters under different dissipation conditions – Comparison with infrared measurements

    OpenAIRE

    Avenas, Yvan; Dupont, Laurent

    2012-01-01

    Junction temperature evaluation is a key parameter used to control a power module assembly. But measuring the junction temperature by thermo-sensitive electrical parameters (TSEPs) does not reveal the actual temperature of the semiconductor device. In this paper, a specific electronic board used to compare four common TSEPs of IGBT chips is presented. For this comparison, two dissipation modes are used: dissipation in active and saturation regions. In order to have referential measurements we...

  2. Job load and hazard analysis: a method for the analysis of workplace conditions for occupational health care.

    OpenAIRE

    Mattila, M K

    1985-01-01

    One requirement for successful occupational health care is reliable information on occupational hazards. The aim of this study was to develop a simple, standardised method for workplace investigations for use in occupational health care. The theoretical framework of the method comprises the stress-strain model, the hazard-danger model, and risk behaviour theory. The new method, termed job load and hazard analysis, includes four stages: identification of hazards, their evaluation, conclusions ...

  3. Impact of different privacy conditions and incentives on survey response rate, participant representativeness, and disclosure of sensitive information: a randomized controlled trial

    Science.gov (United States)

    2014-01-01

    Background Anonymous survey methods appear to promote greater disclosure of sensitive or stigmatizing information compared to non-anonymous methods. Higher disclosure rates have traditionally been interpreted as being more accurate than lower rates. We examined the impact of 3 increasingly private mailed survey conditions—ranging from potentially identifiable to completely anonymous—on survey response and on respondents’ representativeness of the underlying sampling frame, completeness in answering sensitive survey items, and disclosure of sensitive information. We also examined the impact of 2 incentives ($10 versus $20) on these outcomes. Methods A 3X2 factorial, randomized controlled trial of 324 representatively selected, male Gulf War I era veterans who had applied for United States Department of Veterans Affairs (VA) disability benefits. Men were asked about past sexual assault experiences, childhood abuse, combat, other traumas, mental health symptoms, and sexual orientation. We used a novel technique, the pre-merged questionnaire, to link anonymous responses to administrative data. Results Response rates ranged from 56.0% to 63.3% across privacy conditions (p = 0.49) and from 52.8% to 68.1% across incentives (p = 0.007). Respondents’ characteristics differed by privacy and by incentive assignments, with completely anonymous respondents and $20 respondents appearing least different from their non-respondent counterparts. Survey completeness did not differ by privacy or by incentive. No clear pattern of disclosing sensitive information by privacy condition or by incentive emerged. For example, although all respondents came from the same sampling frame, estimates of sexual abuse ranged from 13.6% to 33.3% across privacy conditions, with the highest estimate coming from the intermediate privacy condition (p = 0.007). Conclusion Greater privacy and larger incentives do not necessarily result in higher disclosure rates of sensitive information

  4. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    Science.gov (United States)

    Montaldo, N.; Toninelli, V.; Albertson, J. D.; Mancini, M.; Troch, P. A.

    Recent developments have made land-surface models (LSMs) more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps), a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity) using the TOPLATS model, an existing LSM. In the summer and autumn of 1999, which included both wet (atmosphere controlled) and dry (soil controlled) periods, actual evapotranspiration estimates were performed using Bowen ratio and, for a short period, eddy correlation methods. Measurements performed with the two methods are in good agreement. The calibrated LSM predicts actual evapotranspiration quite well over the whole observation period. A sensitivity analysis of the evapotranspiration to model parameters was performed through the global multivariate technique during both wet and dry periods of the campaign. This approach studies the influence of each parameter without conditioning on certain values of the other variables. Hence, all parameters are varied simultaneously using, for instance, a uniform sampling strategy through a Monte Carlo simulation framework. The evapotranspiration is highly sensitive to the soil parameters, especially during wet periods. However, the evapotranspiration is also sensitive to some vegetation parameters and, during dry periods, wilting point is the most critical for evapotranspiration predictions. This result confirms the importance of correct representation of vegetation properties which, in water-limited conditions, control evapotranspiration.

  5. Tight glycemic control in critical care--the leading role of insulin sensitivity and patient variability: a review and model-based analysis.

    Science.gov (United States)

    Chase, J Geoffrey; Le Compte, Aaron J; Suhaimi, Fatanah; Shaw, Geoffrey M; Lynn, Adrienne; Lin, Jessica; Pretty, Christopher G; Razak, Normy; Parente, Jacquelyn D; Hann, Christopher E; Preiser, Jean-Charles; Desaive, Thomas

    2011-05-01

    Tight glycemic control (TGC) has emerged as a major research focus in critical care due to its potential to simultaneously reduce both mortality and costs. However, repeating initial successful TGC trials that reduced mortality and other outcomes has proven difficult with more failures than successes. Hence, there has been growing debate over the necessity of TGC, its goals, the risk of severe hypoglycemia, and target cohorts. This paper provides a review of TGC via new analyses of data from several clinical trials, including SPRINT, Glucontrol and a recent NICU study. It thus provides both a review of the problem and major background factors driving it, as well as a novel model-based analysis designed to examine these dynamics from a new perspective. Using these clinical results and analysis, the goal is to develop new insights that shed greater light on the leading factors that make TGC difficult and inconsistent, as well as the requirements they thus impose on the design and implementation of TGC protocols. A model-based analysis of insulin sensitivity using data from three different critical care units, comprising over 75,000h of clinical data, is used to analyse variability in metabolic dynamics using a clinically validated model-based insulin sensitivity metric (S(I)). Variation in S(I) provides a new interpretation and explanation for the variable results seen (across cohorts and studies) in applying TGC. In particular, significant intra- and inter-patient variability in insulin resistance (1/S(I)) is seen be a major confounder that makes TGC difficult over diverse cohorts, yielding variable results over many published studies and protocols. Further factors that exacerbate this variability in glycemic outcome are found to include measurement frequency and whether a protocol is blind to carbohydrate administration. PMID:21145614

  6. Sensitivities of crop models to extreme weather conditions during flowering period demonstrated for maize and winter wheat in Austria

    DEFF Research Database (Denmark)

    Eitzinger, J; Thaler, S; Schmid, E;

    2013-01-01

    minimum tillage. Since no comprehensive field experimental data sets were available, a relative comparison of simulated grain yields and soil moisture contents under defined weather scenarios with modified temperatures and precipitation was performed for a 2-week period after flowering. The results may...... start of flowering. Two locations in Austria, representing different agro-climatic zones and soil conditions, were included in the simulations over 2 years, 2003 and 2004, exhibiting contrasting weather conditions. In addition, soil management was modified at both sites by following either ploughing or...... soil tillage practices, which affected soil water storage capacity....

  7. The sensitivity of Sphagnum to surface layer conditions in a re-wetted bog: a simulation study of water stress

    NARCIS (Netherlands)

    Schouwenaars, J.M.; Gosen, A.M.

    2007-01-01

    The behaviour of the water table in re-wetted bogs varies widely between different locations so that recolonising Sphagnum is vulnerable to water stress, especially when the water table is drawn down in summer. It is important to understand how physical site conditions influence the occurrence of wa

  8. Sensitivities of crop models to extreme weather conditions during flowering period demonstrated for maize and winter wheat in Austria

    Czech Academy of Sciences Publication Activity Database

    Eitzinger, Josef; Thaler, S.; Schmid, E.; Strauss, F.; Ferrise, R.; Moriondo, M.; Bindi, M.; Palosuo, T.; Rötter, R.; Kersebaum, K. C.; Olesen, J. E.; Patil, R. H.; Saylan, L.; Çaldag, B.; Caylak, O.

    2013-01-01

    Roč. 151, č. 6 (2013), s. 813-835. ISSN 0021-8596 R&D Projects: GA MŠk(CZ) ED1.1.00/02.0073 Institutional support: RVO:67179843 Keywords : crop models * weather conditions * winter wheat * Austria Subject RIV: EH - Ecology, Behaviour Impact factor: 2.891, year: 2013

  9. QTL mapping of inbreeding-related cold sensitivity and conditional lethality in Drosophila melanogaster

    DEFF Research Database (Denmark)

    Vermeulen, Corneel J.; Bijlsma, R.; Loeschcke, Volker

    2008-01-01

    Inbreeding depression is a central theme within genetics, and is of specific interest for researchers within evolutionary and conservation genetics and animal and plant breeding. Inbreeding effects are thought to be caused by the joint expression of conditional and unconditional deleterious allel...

  10. Community Care for People with Chronic Conditions: An Analysis of Nine Studies of Health and Social Service Utilization in Ontario

    OpenAIRE

    Watt, Susan; Browne, Gina; Gafni, Amiram; Roberts, Jacqueline; Byrne, Carolyn

    1999-01-01

    A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same–or even lower–costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, atleast in a system of national health insurance, will...

  11. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    Directory of Open Access Journals (Sweden)

    N. Montaldo

    2003-01-01

    Full Text Available Recent developments have made land-surface models (LSMs more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps, a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity using the TOPLATS model, an existing LSM. In the summer and autumn of 1999, which included both wet (atmosphere controlled and dry (soil controlled periods, actual evapotranspiration estimates were performed using Bowen ratio and, for a short period, eddy correlation methods. Measurements performed with the two methods are in good agreement. The calibrated LSM predicts actual evapotranspiration quite well over the whole observation period. A sensitivity analysis of the evapotranspiration to model parameters was performed through the global multivariate technique during both wet and dry periods of the campaign. This approach studies the influence of each parameter without conditioning on certain values of the other variables. Hence, all parameters are varied simultaneously using, for instance, a uniform sampling strategy through a Monte Carlo simulation framework. The evapotranspiration is highly sensitive to the soil parameters, especially during wet periods. However, the evapotranspiration is also sensitive to some vegetation parameters and, during dry periods, wilting point is the most critical for evapotranspiration predictions. This result confirms the importance of correct representation of vegetation properties which, in water-limited conditions, control evapotranspiration. Keywords: evapotranspiration, sensitivity analysis, land surface model, eddy correlation, Alpine basin

  12. High Sensitivity C-reactive Protein Levels in Acute Ischemic Stroke and Subtypes: A study from a Tertiary Care Center

    Directory of Open Access Journals (Sweden)

    Jaydip Ray Chaudhuri

    2013-07-01

    Full Text Available Background: Stroke is a heterogeneous disease with several risk factors. High sensitivity C-reactive protein (hsCRP is a marker for cardiovascular and cerebrovascular diseases. Recent studies have shown that high hsCRP level is a risk factor for ischemic stroke. The objective of our study was to investigate the association of high hsCRP(> 3 mg/L levels with ischemic stroke and its subtypes in Indian patients.Methods: We recruited 210 consecutive acute stroke patients and 150 age and sex matched controls. Stroke patients were admitted within 72 hours of onset, at Yashoda Hospital, Hyderabad, India. The study period was from January 2011 to December 2012. All patients underwent tests as per standard protocol for stroke workup. Serum hsCRP level was assessed in all stroke patients and controls on the day of admission.Results: The mean hsCRP was significantly higher in stroke patients (3.8 ± 2.5 than controls (1.8 ± 1.5 (P < 0.001. High hsCRP had higher frequency in stroke patients 130 (61.9% compared to controls 10 (6.6%, P < 0.001. High hsCRP level was more prevalent in the stroke subtypes of cardioembolic stroke (83.3% and large artery atherosclerosis (72%. High hsCRP level was significantly associated with hypercholesterolemia (P = 0.001, age(P = 0.01, and mortality (0.04. After adjustment of regression analysis it was observed that high level hsCRP is independently associated with acute ischemic stroke (Odds 4.5; 95% CI: 2.5-12.2; especially the stroke subtypes of cardioembolic stroke, (odds ratio 3.4, 95% CI: 1.9-10.5 and large artery atherosclerosis (odds ratio 2.1, 95% CI: 1.5-3.8.Conclusion: High hsCRP level is strongly associated with and an independent predictor of acute ischemic stroke. The association was found in all ischemic stroke subtypes.

  13. Application of the statistical safety evaluation method to the small break LOCA with high pressure injection failure. Sensitivity analyses to determine the break conditions

    International Nuclear Information System (INIS)

    By applying a statistical safety evaluation method, the uncertainties of best estimate results can be estimated quantitatively, and as a consequence, excessive conservatism can be reasonably removed to obtain evaluation results with enhanced reliability. Application of a statistical evaluation method is being made to analyses of the “low pressure injection by intentional depressurization of the steam generator secondary side” which is an accident management approach in a SBLOCA (small break loss-of-coolant accident) with HPI (high pressure injection) failure. At the time of a SBLOCA, the break conditions such as the break size are important parameters since they influence PCT (peak cladding temperature). In this research, sensitivity analyses about the break size, direction and position were carried out for a system plant under a condition which the start timing of the steam generator secondary side intentional depressurization is severer than an actual abnormal operating condition. From the result of the sensitivity analyses, differences in the phenomena progression which change depending on the break conditions were evaluated, and a 3 inch facing-down break of the cold-leg was determined as the base case of a statistical safety evaluation. (author)

  14. Modelling conditions and health care processes in electronic health records: an application to severe mental illness with the clinical practice research datalink

    OpenAIRE

    Olier, I.; Springate, DA; Ashcroft, DM; Doran, T.; Reeves, D; Planner, C.; Reilly, S; Kontopantelis, E

    2016-01-01

    Background The use of Electronic Health Records databases for medical research has become mainstream. In the UK, increasing use of Primary Care Databases is largely driven by almost complete computerisation and uniform standards within the National Health Service. Electronic Health Records research often begins with the development of a list of clinical codes with which to identify cases with a specific condition. We present a methodology and accompanying Stata and R commands (pcdsearch/Rp...

  15. Stress-induced enhancement of fear conditioning and sensitization facilitates extinction-resistant and habituation-resistant fear behaviors in a novel animal model of posttraumatic stress disorder.

    Science.gov (United States)

    Corley, Michael J; Caruso, Michael J; Takahashi, Lorey K

    2012-01-18

    Posttraumatic stress disorder (PTSD) is characterized by stress-induced symptoms including exaggerated fear memories, hypervigilance and hyperarousal. However, we are unaware of an animal model that investigates these hallmarks of PTSD especially in relation to fear extinction and habituation. Therefore, to develop a valid animal model of PTSD, we exposed rats to different intensities of footshock stress to determine their effects on either auditory predator odor fear extinction or habituation of fear sensitization. In Experiment 1, rats were exposed to acute footshock stress (no shock control, 0.4 mA, or 0.8 mA) immediately prior to auditory fear conditioning training involving the pairing of auditory clicks with a cloth containing cat odor. When presented to the conditioned auditory clicks in the next 5 days of extinction testing conducted in a runway apparatus with a hide box, rats in the two shock groups engaged in higher levels of freezing and head out vigilance-like behavior from the hide box than the no shock control group. This increase in fear behavior during extinction testing was likely due to auditory activation of the conditioned fear state because Experiment 2 demonstrated that conditioned fear behavior was not broadly increased in the absence of the conditioned auditory stimulus. Experiment 3 was then conducted to determine whether acute exposure to stress induces a habituation resistant sensitized fear state. We found that rats exposed to 0.8 mA footshock stress and subsequently tested for 5 days in the runway hide box apparatus with presentations of nonassociative auditory clicks exhibited high initial levels of freezing, followed by head out behavior and culminating in the occurrence of locomotor hyperactivity. In addition, Experiment 4 indicated that without delivery of nonassociative auditory clicks, 0.8 mA footshock stressed rats did not exhibit robust increases in sensitized freezing and locomotor hyperactivity, albeit head out vigilance

  16. Implementation of Adolescent Family-Based Substance Use Prevention Programmes in Health Care Settings: Comparisons across Conditions and Programmes

    Science.gov (United States)

    Aalborg, Annette E.; Miller, Brenda A.; Husson, Gail; Byrnes, Hilary F.; Bauman, Karl E.; Spoth, Richard L.

    2012-01-01

    Objective: To examine factors that influence the effectiveness and quality of implementation of evidence-based family-focused adolescent substance use prevention programmes delivered in health care settings and to assess the effects of programme choice versus programme assignment on programme delivery. Design: Strengthening Families Program: For…

  17. Assessing the sensitivity of Melanoplus frigidus (Orthoptera:Acrididae) to different weather conditions: A modeling approach focussing on development times

    Institute of Scientific and Technical Information of China (English)

    Oliver-D. Finch; J(o)rg L(o)ffler; Roland Pape

    2008-01-01

    The temperature and soil moisture conditions as well as vegetation patterns were studied to describe the habitat and to model the life cycle of Melanoplusfrigidus, a true alpine grasshopper of the Scandes. In the low alpine belt of the Norwegian Scandes the species colonizes only the warmest microhabitats with maximum soil surface temperatures of 31℃. Vegetation of these habitats consists of shrub-rich heath dominated by Vaccinium myrtillus and Calluna vulgaris. Using continuously measured temperature data, the development times for four different seasons were modeled and related to field observations. The maximum delay of adult molt was estimated to amount to 3 weeks, the delay being determined by the variation in spring temperature conditions between different years. The possibilities of using M. frigidus as an indicator organism of climate change effects on alpine zoo-coenoses of the Scandes are discussed.

  18. Modification of radio-sensitivity of human normal and trisomy-21 fibroblasts by irradiation under hypoxic condition

    International Nuclear Information System (INIS)

    The authors previously reported that fibroblasts from Trisomy-21 patients were moderately radiosensitive; however, DMSO reduced x-ray induced cytotoxicity in trisomy-21 cells more than in normal fibroblasts. Human trisomy-21 cells contain 150% the normal level of Cu-Zn SOD (superoxide dismutase). These genes are located on chromosome-21. Production of superoxide radical anions (O/sub 2//sup -/) is an initial radiation-induced reaction, followed by H/sub 2/O/sub 2/, OH . and finally H/sub 2/O. In present study, confluent cultures of skin fibroblasts form normal and trisomy-21 individuals were irradiated in air and under hypoxic conditions. The cells were subcultured immediately and reseeded at low density to measure colony forming ability. The D/sub O/ of the survival curves for trisomy-21 cell strains irradiated in air were 80-100 rads with no or small shoulder regions, as compared with 120-150 rads with noticeable shoulder regions for normal strains. The enhancement ratios for survival of trisomy-21 fibroblasts irradiated under hypoxic conditions were nearly 2-3 times higher than for normal fibroblasts. The enhanced survival under hypoxic conditions was due to large increases in the shoulder regions and some increase in D/sub O/ values for both normal and Trisomy-21 cells. Further experiments are currently in progress to better define this effect

  19. The sensitivity of Sphagnum to surface layer conditions in a re-wetted bog: a simulation study of water stress

    Directory of Open Access Journals (Sweden)

    J.M. Schouwenaars

    2007-04-01

    Full Text Available The behaviour of the water table in re-wetted bogs varies widely between different locations so that recolonising Sphagnum is vulnerable to water stress, especially when the water table is drawn down in summer. It is important to understand how physical site conditions influence the occurrence of water stress so that adequate management measures may be applied. In the work reported here, the respective roles of the hydrophysical properties of the uppermost peat layer and micro-scale site conditions are investigated using a Soil-Water-Atmosphere-Plant (SWAP model, which simulates water table fluctuations and soil moisture conditions. The variables are: (a cover and thickness of the Sphagnum layer, (b microtopography (presence of open water, (c hydrophysical properties of the uppermost soil layer and (d rate of downward seepage. Data for the model are derived from field observations, from published literature, and from laboratory determinations of moisture characteristic curves and saturated and unsaturated hydraulic conductivity (k–h–Θ relationships for peat. The simulation indicates that microtopography and the thickness of the moss layer are the dominant factors affecting groundwater behaviour and the risk of water stress. Sphagnum layers a few centimetres thick should be relatively well supplied with water from the underlying peat but as the Sphagnum carpet thickens, water movement through the unsaturated zone to the growing capitula will become increasingly difficult. Sphagnum layers appear to be most vulnerable to water stress when they are 5–15 cm thick. Beyond this thickness, water stored within the Sphagnum layer itself begins to offset the decline in the flux from below, and thus to reduce the dependence of the water supply to the stem tips on the maintenance of hydraulic continuity with the water table. The results obtained using the model underline the close interdependence between Sphagnum development and the accompanying

  20. Sensitive detection of gene expression in mycobacteria under replicating and non-replicating conditions using optimized far-red reporters.

    Directory of Open Access Journals (Sweden)

    Paul Carroll

    Full Text Available Fluorescent reporter proteins have proven useful for imaging techniques in many organisms. We constructed optimized expression systems for several fluorescent proteins from the far-red region of the spectrum and analyzed their utility in several mycobacterial species. Plasmids expressing variants of the Discosoma Red fluorescent protein (DsRed from the Mycobacterium bovis hsp60 promoter were unstable; in contrast expression from the Mycobacterium smegmatis rpsA promoter was stable. In Mycobacterium tuberculosis expression of several of the far-red reporters was readily visualised by eye and three reporters (mCherry, tdTomato, and Turbo-635 fluoresced at a high intensity. Strains expressing mCherry showed no fitness defects in vitro or in macrophages. Treatment of cells with antibiotics demonstrated that mCherry could also be used as a reporter for cell death, since fluorescence decreased in the presence of a bactericidal compound, but remained stable in the presence of a bacteriostatic compound. mCherry was functional under hypoxic conditions; using mCherry we demonstrated that the P(mtbB is expressed early in hypoxia and progressively down-regulated. mCherry and other far-red fluorescent proteins will have multiple uses in investigating the biology of mycobacteria, particularly under non-replicating, or low cell density conditions, as well as providing a novel means of detecting cell death rapidly.

  1. Analysis of blood pressure–heart rate feedback regulation under non-stationary conditions: beyond baroreflex sensitivity

    International Nuclear Information System (INIS)

    The feedback regulation of blood pressure and heart rate is an important indicator of human autonomic function usually assessed by baroreflex sensitivity (BRS). We suggest a new method yielding a higher temporal resolution than standard BRS methods. Our approach is based on a regression analysis of the first differences of inter-heartbeat intervals and blood pressure values. Data are recorded from 23 patients with hypertension and sleep apnoea, 22 patients with diabetes mellitus and 23 healthy subjects. Using the proposed method for 3 min data segments, we obtain average regression coefficients of 9.1 and 3.5 ms mmHg−1 for healthy subjects in supine and orthostatic positions, respectively. In patients with hypertension, we find them to be 3.8 and 2.6 ms mmHg−1. The diabetes patients with and without autonomic neuropathy are characterized by 3.1 and 6.1 ms mmHg−1 in the supine position compared with 1.7 and 3.3 ms mmHg−1 in the orthostatic position. The results are highly correlated with conventional BRS measures; we find r > 0.9 for the dual sequence method. Therefore, we suggest that the new method can quantify BRS. It is superior in distinguishing healthy subjects from patients both in supine and orthostatic positions for short-term recordings. It is suitable for non-stationary data and has good reproducibility. Besides, we cannot exclude that other regulatory mechanisms than BRS may also contribute to the regression coefficients between the first differences

  2. The problems of the providing the regions with health care infrastructure in conditions of increase of migratory mobility

    Directory of Open Access Journals (Sweden)

    Yelena Borisovna Bedrina

    2013-06-01

    Full Text Available Subject matter of the article is a question of the providing the newcomers to regions of the Russian Federation with healthcare infrastructure facilities. The purpose of the research is an assessment of level of this providing. On the basis of calculation of the integrated indicators of the development of health care infrastructure and the providing the population with healthcare infrastructure facilities the grouping of regions is carried out. By means of the two-dimensional analysis, we made a comparison of regions on indicators of arrival of the population and the above-named settlement indicators. The analysis of dynamics of the number change of healthcare infrastructure facilities during its reforming from 2005 to 2011 is performed. As a result of the research, the following conclusion is drawn: the level of investment into the regions as well as in its health care infrastructure do influence on the intensity of migratory flows, however, distribution of investments into health care facilities in regions does not take in to account the directions of migratory flows and poorly considers the population size of territories. This article may be interesting to the experts dealing with issues of development of regions.

  3. Oral care.

    Science.gov (United States)

    Hitz Lindenmüller, Irène; Lambrecht, J Thomas

    2011-01-01

    Adequate dental and oral hygiene may become a challenge for all users and especially for elderly people and young children because of their limited motor skills. The same holds true for patients undergoing/recovering from chemo-/radiotherapy with accompanying sensitive mucosal conditions. Poor dental hygiene can result in tooth decay, gingivitis, periodontitis, tooth loss, bad breath (halitosis), fungal infection and gum diseases. The use of a toothbrush is the most important measure for oral hygiene. Toothbrushes with soft bristles operated carefully by hand or via an electric device help to remove plaque and to avoid mucosal trauma. A handlebar with a grip cover can be helpful for manually disabled patients or for those with reduced motor skills. In case of oral hygiene at the bedside or of patients during/after chemo-/radiotherapy a gauze pad can be helpful for gently cleaning the teeth, gums and tongue. The use of fluoride toothpaste is imperative for the daily oral hygiene. Detergents such as sodium lauryl sulphate improve the cleaning action but may also dehydrate and irritate the mucous membrane. The use of products containing detergents and flavouring agents (peppermint, menthol, cinnamon) should therefore be avoided by bedridden patients or those with dry mouth and sensitive mucosa. Aids for suitable interdental cleaning, such as dental floss, interdental brushes or dental sticks, are often complicated to operate. Their correct use should be instructed by healthcare professionals. To support dental care, additional fluoridation with a fluoride gel or rinse can be useful. Products further containing antiseptics such as chlorhexidine or triclosan reduce the quantity of bacteria in the mouth. For patients undergoing or having undergone radio-/chemotherapy, a mouthwash that concomitantly moisturizes the oral mucosa is advisable. PMID:21325845

  4. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health.

    Science.gov (United States)

    Rasooly, Reuven; Bruck, Hugh Alan; Balsam, Joshua; Prickril, Ben; Ossandon, Miguel; Rasooly, Avraham

    2016-01-01

    Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD) cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB), and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1) image stacking to improve signal-to-noise ratios; (2) lasers to enable fluorescence excitation for flow cytometry; and (3) streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities), and provide for their use in low-cost medical diagnostics in resource-poor settings. PMID:27196933

  5. Improving the Sensitivity and Functionality of Mobile Webcam-Based Fluorescence Detectors for Point-of-Care Diagnostics in Global Health

    Directory of Open Access Journals (Sweden)

    Reuven Rasooly

    2016-05-01

    Full Text Available Resource-poor countries and regions require effective, low-cost diagnostic devices for accurate identification and diagnosis of health conditions. Optical detection technologies used for many types of biological and clinical analysis can play a significant role in addressing this need, but must be sufficiently affordable and portable for use in global health settings. Most current clinical optical imaging technologies are accurate and sensitive, but also expensive and difficult to adapt for use in these settings. These challenges can be mitigated by taking advantage of affordable consumer electronics mobile devices such as webcams, mobile phones, charge-coupled device (CCD cameras, lasers, and LEDs. Low-cost, portable multi-wavelength fluorescence plate readers have been developed for many applications including detection of microbial toxins such as C. Botulinum A neurotoxin, Shiga toxin, and S. aureus enterotoxin B (SEB, and flow cytometry has been used to detect very low cell concentrations. However, the relatively low sensitivities of these devices limit their clinical utility. We have developed several approaches to improve their sensitivity presented here for webcam based fluorescence detectors, including (1 image stacking to improve signal-to-noise ratios; (2 lasers to enable fluorescence excitation for flow cytometry; and (3 streak imaging to capture the trajectory of a single cell, enabling imaging sensors with high noise levels to detect rare cell events. These approaches can also help to overcome some of the limitations of other low-cost optical detection technologies such as CCD or phone-based detectors (like high noise levels or low sensitivities, and provide for their use in low-cost medical diagnostics in resource-poor settings.

  6. Relative sensitivity of five Hawaiian coral species to high temperature under high-pCO2 conditions

    Science.gov (United States)

    Bahr, Keisha D.; Jokiel, Paul L.; Rodgers, Ku'ulei S.

    2016-06-01

    Coral reef ecosystems are presently undergoing decline due to anthropogenic climate change. The chief detrimental factors are increased temperature and increased pCO2. The purpose of this study was to evaluate the effect of these two stressors operating independently and in unison on the biological response of common Hawaiian reef corals. Manipulative experiments were performed using five species ( Porites compressa, Pocillopora damicornis, Fungia scutaria, Montipora capitata, and Leptastrea purpurea) in a continuous-flow mesocosm system under natural sunlight conditions. Corals were grown together as a community under treatments of high temperature (2 °C above normal maximum summer temperature), high pCO2 (twice present-day conditions), and with both factors acting in unison. Control corals were grown under present-day pCO2 and at normal summer temperatures. Leptastrea purpurea proved to be an extremely hardy coral. No change in calcification or mortality occurred under treatments of high temperature, high pCO2, or combined high temperature-high pCO2. The remaining four species showed reduced calcification in the high-temperature treatment. Two species ( L. purpurea and M. capitata) showed no response to increased pCO2. Also, high pCO2 ameliorated the negative effect of high temperature on the calcification rates of P. damicornis. Mortality was driven primarily by high temperature, with a negative synergistic effect in P. compressa only in the high-pCO2-high-temperature treatment. Results support the observation that biological response to temperature and pCO2 elevation is highly species-specific, so generalizations based on response of a single species might not apply to a diverse and complex coral reef community.

  7. A Legal and Ethical Analysis of the Effects of Triggering Conditions on Surrogate Decision-Making in End-of-Life Care in the US.

    Science.gov (United States)

    Clint Parker, J; Goldberg, Daniel S

    2016-03-01

    The central claim of this paper is that American states' use of so-called "triggering conditions" to regulate surrogate decision-making authority in end-of-life care leaves unresolved a number of important ethical and legal considerations regarding the scope of that authority. The paper frames the issue with a case set in a jurisdiction in which surrogate authority to withdraw life-sustaining treatment is triggered by two specific clinical conditions. The case presents a quandary insofar as the clinical facts do not satisfy the triggering conditions, and yet both the appropriate surrogates and the care team agree that withdrawal of life-sustaining treatment is in the best interest of the patient. The paper surveys applicable law across the 50 states and weighs the arguments for and against the inclusion of such triggering conditions in relevant legal regimes. The paper concludes by assessing the various legal and policy options states have for regulating surrogate decision-making authority in light of the moral considerations (including epistemic difficulties), and notes the possibility for conflict within ethics teams arising from the potential tension between prudence, risk-aversion, and moral obligation. PMID:26084270

  8. A Rapid and Sensitive Next-Generation Sequencing Method to Detect RB1 Mutations Improves Care for Retinoblastoma Patients and Their Families.

    Science.gov (United States)

    Li, Wenhui L; Buckley, Jonathan; Sanchez-Lara, Pedro A; Maglinte, Dennis T; Viduetsky, Lucy; Tatarinova, Tatiana V; Aparicio, Jennifer G; Kim, Jonathan W; Au, Margaret; Ostrow, Dejerianne; Lee, Thomas C; O'Gorman, Maurice; Judkins, Alexander; Cobrinik, David; Triche, Timothy J

    2016-07-01

    Retinoblastoma is a childhood eye malignancy that can lead to the loss of vision, eye(s), and sometimes life. The tumors are initiated by inactivating mutations in both alleles of the tumor-suppressor gene, RB1, or, rarely, by MYCN amplification. Timely identification of a germline RB1 mutation in blood samples or either somatic RB1 mutation or MYCN amplification in tumors is important for effective care and management of retinoblastoma patients and their families. However, current procedures to thoroughly test RB1 mutations are complicated and lengthy. Herein, we report a next-generation sequencing-based method capable of detecting point mutations, small indels, and large deletions or duplications across the entire RB1 gene and amplification of MYCN gene on a single platform. From DNA extraction to clinical interpretation requires only 3 days, enabling early molecular diagnosis of retinoblastoma and optimal treatment outcomes. This method can also detect low-level mosaic mutations in blood samples that can be missed by routine Sanger sequencing. In addition, it can differentiate between RB1 mutation- and MYCN amplification-driven retinoblastomas. This rapid, comprehensive, and sensitive method for detecting RB1 mutations and MYCN amplification can readily identify RB1 mutation carriers and thus improve the management and genetic counseling for retinoblastoma patients and their families. PMID:27155049

  9. O6-Methylguanine-Methyltransferase (MGMT Promoter Methylation Status in Glioma Stem-Like Cells is Correlated to Temozolomide Sensitivity Under Differentiation-Promoting Conditions

    Directory of Open Access Journals (Sweden)

    Lucie Karayan-Tapon

    2012-06-01

    Full Text Available Glioblastoma (GBM is the most malignant type of primary brain tumor with a very poor prognosis. The actual standard protocol of treatment for GBM patients consists of radiotherapy and concomitant temozolomide (TMZ. However, the therapeutic efficacy of this treatment is limited due to tumor recurrence and TMZ resistance. Recently isolated, glioma stem-like cells (GSCs are thought to represent the population of tumorigenic cells responsible for GBM resistance and recurrence following surgery and chemotherapy. In addition, MGMT (O6-methylguanine-methyltransferase methylation is considered as one of the principal mechanisms contributing to TMZ sensitivity of GBM. In this study we have isolated GSCs from 10 adult GBM patients and investigated the relationship between MGMT methylation status and Temozolomide (TMZ sensitivity of these lines grown either in stem-like or differentiation promoting conditions. Sensitivity to TMZ was significantly associated with MGMT methylation status in cells committed to differentiation but not in stem-like cells. In addition, patients harboring highly methylated MGMT promoters had a longer overall survival. These results reveal the importance of the differentiation process when considering the predictive value of MGMT status in GSCs for clinical response to TMZ.

  10. Approaches to managing uncertainty in people with life-limiting conditions: role of communication and palliative care.

    Science.gov (United States)

    Etkind, S N; Koffman, J

    2016-07-01

    Patients with any major illness can expect to experience uncertainty about the nature of their illness, its treatment and their prognosis. Prognostic uncertainty is a particular source of patient distress among those living with life-limiting disease. Uncertainty also affects professionals and it has been argued that the level of professional tolerance of uncertainty can affect levels of investigation as well as healthcare resource use. We know that the way in which uncertainty is recognised, managed and communicated can have important impacts on patients' treatment and quality of life. Current approaches to uncertainty in life-limiting illness include the use of care bundles and approaches that focus on communication and education. The experience in communicating in difficult situations that specialist palliative care professionals can provide may also be of benefit for patients with life-limiting illness in the context of uncertainty. While there are a number of promising approaches to uncertainty, as yet few interventions targeted at recognising and addressing uncertainty have been fully evaluated and further research is needed in this area. PMID:27129911

  11. Prescription Drug Use Among Adults With Chronic Conditions in South Korea: Dual Burden of Health Care Needs and Socioeconomic Vulnerability.

    Science.gov (United States)

    Jung, Youn; Byeon, Jinok; Chung, Haejoo

    2016-01-01

    The aim of this study is to identify the social determinants of prescription drug use among adults with chronic diseases by examining the associations between socioeconomic position and prescription medicine use and perceived burden for pharmaceutical expenditure, using a sample of the Korean population from the 2008 Korea Health Panel, with 4 analytic models. Controlled with health status and the type of health insurance, the probability of using prescription drugs and overall spending on drugs significantly increased with rising income level, while perceived burden for out-of-pocket payment significantly decreased. These results imply that the poor are likely to underuse prescription drugs compared with their wealthier counterparts with the same need for health care, probably due to economic barriers. PMID:26512028

  12. Palliative Care

    Science.gov (United States)

    ... Diseases & Conditions Pregnancy & Baby Nutrition & Fitness Emotions & Behavior School & Family Life First Aid & Safety Doctors & Hospitals Q&A ... assess the complex needs of the patient and family, facilitate communication with the care team and within the family, ...

  13. Hospice Care

    Science.gov (United States)

    ... your care. Other team members may include a music therapist, physical therapist, speech therapist or occupational therapist. ... to the Terms and Conditions and Privacy Policy Popular Articles 1 Understanding Blood Pressure Readings 2 Sodium ...

  14. Non-neuronal, but atropine-sensitive ileal contractile responses to short-chain fatty acids: age-dependent desensitization and restoration under inflammatory conditions in mice.

    Science.gov (United States)

    Yajima, Masako; Kimura, Shunsuke; Karaki, Shinichiro; Nio-Kobayashi, Junko; Tsuruta, Takeshi; Kuwahara, Atsukazu; Yajima, Takaji; Iwanaga, Toshihiko

    2016-04-01

    Intestinal epithelial cells sense short-chain fatty acids (SCFAs) to secrete non-neuronal acetylcholine (ACh). However, the roles of luminalSCFAs and epithelialACh under normal and pathological conditions remain unknown. We examined ileal contractile responses toSCFAs at different ages and their mucosal cholinergic alterations under inflammatory conditions. Ileal contractile responses toSCFAs in 1-day-old pups to 7-week-old mice were compared using an isotonic transducer, and responses to an intraperitoneal injection of lipopolysaccharide (LPS) were analyzed in 7-week-old mice. ThemRNAexpression levels of aSCFAactivate free fatty acid receptor, acetylcholinesterase (AChE), choline acetyltransferase (Chat), and choline transporter-like protein 4 (CTL4) were measured using real-time quantitativeRT-PCRAChE was analyzed by histochemical and optical enzymatic assays. Atropine-sensitive ileal contractile responses toSCFAs occurred in all 1-day-old pups, but were frequently desensitized after the weaning period. These contractile responses were not inhibited by tetrodotoxin and did not appear when the mucosal layer had been scraped off. Contractile desensitization in 7-week-old mice was abolished in the presence of theAChE inhibitor, eserine, which was consistent with increasedAChE activity after weaning. Ileal contractions toSCFAs in adult mice were restored byLPS, which significantly increased the epithelialmRNAexpression of Chat andCTL4. Atropine-sensitive ileal contractile responses toSCFAs constitutively occur in the newborn period, and are desensitized during developmental stages following the up-regulated expression ofAChE in the villous mucosa, but are restored under inflammatory conditions possibly via the release of epithelialACh. PMID:27053293

  15. Challenges of nurse delivery of psychological interventions for long-term conditions in primary care: a qualitative exploration of the case of chronic fatigue syndrome/myalgic encephalitis

    Directory of Open Access Journals (Sweden)

    Peters Sarah

    2011-12-01

    Full Text Available Abstract Background The evidence base for a range of psychosocial and behavioural interventions in managing and supporting patients with long-term conditions (LTCs is now well-established. With increasing numbers of such patients being managed in primary care, and a shortage of specialists in psychology and behavioural management to deliver interventions, therapeutic interventions are increasingly being delivered by general nurses with limited training in psychological interventions. It is unknown what issues this raises for the nurses or their patients. The purpose of the study was to examine the challenges faced by non-specialist nurses when delivering psychological interventions for an LTC (chronic fatigue syndrome/myalgic encephalomyelitis [CFS/ME] within a primary care setting. Methods A qualitative study nested within a randomised controlled trial [ISRCTN 74156610] explored the experiences and acceptability of two different psychological interventions (pragmatic rehabilitation and supportive listening from the perspectives of nurses, their supervisors, and patients. Semi structured in-depth interviews were conducted with three nurse therapists, three supervisors, and 46 patients. An iterative approach was used to develop conceptual categories from the dataset. Results Analyses identified four sets of challenges that were common to both interventions: (i being a novice therapist, (ii engaging patients in the therapeutic model, (iii dealing with emotions, and (iv the complexity of primary care. Each challenge had the potential to cause tension between therapist and patient. A number of strategies were developed by participants to manage the tensions. Conclusions Tensions existed for nurses when attempting to deliver psychological interventions for patients with CFS/ME in this primary care trial. Such tensions should be addressed before implementing psychological interventions within routine clinical practice. Similar tensions may be found

  16. Optimization of Extraction Conditions and Development of a Sensitive HPTLC Method for Estimation of Wedelolactone in different extracts of Eclipta alba

    Directory of Open Access Journals (Sweden)

    Kulkarni Savita

    2011-01-01

    Full Text Available Eclipta alba has been used in Ayurvedic medicine for treatment of various ailments. An attempt has been made to optimize different extraction conditions for Eclipta alba. Further an accurate, precise, reproducible and sensitive accurate, precise and reproducible (HPTLC method has been developed for the estimation of Wedelolactone in Eclipta alba. An attempt has been made to quantify wedelolactone in various extracts by HPTLC method. Precoated aluminum silica gel F plates were used as stationary phase and toluene: ethyl acetate (9:1 was used as mobile phase. This system was found to give compact spots for wedelolactone (RF value of 0.30 ± 0. 3 with a linearity range of 1 to 80 µg per spot. The proposed method was applied to evaluate efficiency of different methods of extraction i.e. percolation, maceration, hot solvent extraction (Soxhlet apparatus, supercritical fluid extraction, microwave, orbital shaker bath and sonication method for extraction of wedelolactone from Eclipta alba.

  17. Uncertainty and sensitivity analysis for two-phase flow in the vicinity of the repository in the 1996 performance assessment for the Waste Isolation Pilot Plant: Undisturbed conditions

    Energy Technology Data Exchange (ETDEWEB)

    HELTON,JON CRAIG; BEAN,J.E.; ECONOMY,K.; GARNER,J.W.; MACKINNON,ROBERT J.; MILLER,JOEL D.; SCHREIBER,JAMES D.; VAUGHN,PALMER

    2000-05-19

    Uncertainty and sensitivity analysis results obtained in the 1996 performance assessment for the Waste Isolation Pilot Plant are presented for two-phase flow the vicinity of the repository under undisturbed conditions. Techniques based on Latin hypercube sampling, examination of scatterplots, stepwise regression analysis, partial correlation analysis and rank transformation are used to investigate brine inflow, gas generation repository pressure, brine saturation and brine and gas outflow. Of the variables under study, repository pressure is potentially the most important due to its influence on spallings and direct brine releases, with the uncertainty in its value being dominated by the extent to which the microbial degradation of cellulose takes place, the rate at which the corrosion of steel takes place, and the amount of brine that drains from the surrounding disturbed rock zone into the repository.

  18. Regional climate simulations over South America: sensitivity to model physics and to the treatment of lateral boundary conditions using the MM5 model

    Science.gov (United States)

    Solman, Silvina A.; Pessacg, Natalia L.

    2012-01-01

    In this study the capability of the MM5 model in simulating the main mode of intraseasonal variability during the warm season over South America is evaluated through a series of sensitivity experiments. Several 3-month simulations nested into ERA40 reanalysis were carried out using different cumulus schemes and planetary boundary layer schemes in an attempt to define the optimal combination of physical parameterizations for simulating alternating wet and dry conditions over La Plata Basin (LPB) and the South Atlantic Convergence Zone regions, respectively. The results were compared with different observational datasets and model evaluation was performed taking into account the spatial distribution of monthly precipitation and daily statistics of precipitation over the target regions. Though every experiment was able to capture the contrasting behavior of the precipitation during the simulated period, precipitation was largely underestimated particularly over the LPB region, mainly due to a misrepresentation in the moisture flux convergence. Experiments using grid nudging of the winds above the planetary boundary layer showed a better performance compared with those in which no constrains were imposed to the regional circulation within the model domain. Overall, no single experiment was found to perform the best over the entire domain and during the two contrasting months. The experiment that outperforms depends on the area of interest, being the simulation using the Grell (Kain-Fritsch) cumulus scheme in combination with the MRF planetary boundary layer scheme more adequate for subtropical (tropical) latitudes. The ensemble of the sensitivity experiments showed a better performance compared with any individual experiment.

  19. Competition and sensitivity of wheat and wild oat exposed to enhanced UV-B radiation at different densities under field conditions

    International Nuclear Information System (INIS)

    The influence of enhanced UV-B radiation (approximating a 15% ozone layer reduction) on competitive interaction between spring wheat (Triticum aestivum) and wild oat (Avena fatua) was examined in the field. The density-dependent mortality of both wheat and wild oat did not exhibit a significant difference between control and UV-B treatment conditions. A relatively high degree of competitive stress enhanced the effects of UV-B stress on biomass reduction. The relative competitive status of wheat in terms of total biomass increased under UV-B enhancement while it decreased when based upon grain production. Shifts in competitive balance occurred with significant changes in total biomass, especially when plants grew at higher densities in monocultures and mixtures. The sensitivity of wild oat to intensification of UV-B radiation at higher densities in mixtures was greater than that at lower densities. At all densities examined, wheat grown in mixture was significantly less sensitive to UV-B radiation than that in monoculture, and just the opposite for wild oat. The density of monocultures did not alter the response index (RI) of wheat and wild oat to enhanced UV-B radiation. (author)

  20. A yeast Ubc9 mutant protein with temperature-sensitive in vivo function is subject to conditional proteolysis by a ubiquitin- and proteasome-dependent pathway.

    Science.gov (United States)

    Betting, J; Seufert, W

    1996-10-18

    The UBC9 gene of the yeast Saccharomyces cerevisiae is essential for cell viability and encodes a soluble protein of the nucleus that is metabolically stable. Products of mutant alleles selected to confer temperature-sensitive in vivo function were found to be extremely short-lived at the restrictive but long-lived at the permissive condition. An extragenic suppressor mutation was isolated which increased thermoresistance of a ubc9-1 strain. This suppressor turned out to stabilize the mutated gene product, indicating that the physiological activity of ubc9-1 protein is primarily controlled by conditional proteolysis. The labile ubc9-1 protein appears to be a substrate for ubiquitination, and its turnover was substantially reduced by expression of a ubiquitin derivative that interferes with formation of multi-ubiquitin chains. Stabilization resulted also from competitive inhibition of Ubc4-related ubiquitin-conjugating enzymes. Activity of the proteasome complex was crucial to rapid breakdown, whereas vacuolar proteases were dispensable. Thus, the heat-denatured ubc9-1 protein is targeted for proteolysis by the ubiquitin-proteasome pathway and may serve as a useful tool to further define the process by which a misfolded polypeptide is recognized. PMID:8824207

  1. The temperature sensitivity of heterotrophic respiration controls initial conditions and soil carbon resilience to global warming in CMIP5 models (Invited)

    Science.gov (United States)

    Exbrayat, J.; Pitman, A. J.; Abramowitz, G.

    2013-12-01

    In recent years, biogeochemical models have been implemented in the land component of global circulation models to investigate the interactions between the global terrestrial carbon cycle, anthropogenic CO2 emissions and global warming. These models are now the state-of-the-art tools used in the fifth phase of the Coupled Model Intercomparison Project (CMIP5) and the Intergovernmental Panel on Climate Change fifth Assessment Report (IPCC AR5). Usually, in each grid cell microbial decomposition and routing of soil organic matter between pools of different turn-over time is modelled as a first-order kinetics controlled by a pool-specific residence time. It is adjusted by response functions to environmental conditions and then applied to the pool size. One result of this methodology is a six-fold range (~500 to 3,000 Pg C) variation in total soil carbon simulated at the end of the CMIP5 historical simulations (1850 - 2005). Resolving why this range exists is crucial to understanding the large CMIP5 ensemble spread in projected land-atmosphere fluxes. In this talk, we show that the present CMIP5 range is already established in 1850. We demonstrate that it is an artefact of the representation of microbial decomposition during model initialization under constant pre-industrial atmospheric CO2. We then use a simple model representative of the first-order parameterization of heterotrophic respiration (Rh) that is driven by primary productivity and soil temperature data from a representative global climate model. Our setup is able to reproduce the CMIP5 range in initial conditions by changing one parameter and the formulation of the temperature sensitivity of Rh. Further, we show that the global response of soil carbon during historical simulations and 21st century projections under the Representative Concentration Pathway 8.5 strongly depends on initial conditions in both our simple model and CMIP5 simulations. This can switch soils from a net sink to a net source of

  2. Addition of docetaxel or bisphosphonates to standard of care in men with localised or metastatic, hormone-sensitive prostate cancer: a systematic review and meta-analyses of aggregate data

    OpenAIRE

    Vale, C.L.; Burdett, S; Rydzewska, L. H.; Albiges, L; Clarke, N W; Fisher, D; Fizazi, K; Gravis, G.; James, N. D.; Mason, M D; Parmar, M. K.; Sweeney, C. J.; Sydes, M. R.; Tombal, B.; Tierney, J. F.

    2016-01-01

    Summary Background Results from large randomised controlled trials combining docetaxel or bisphosphonates with standard of care in hormone-sensitive prostate cancer have emerged. In order to investigate the effects of these therapies and to respond to emerging evidence, we aimed to systematically review all relevant trials using a framework for adaptive meta-analysis. Methods For this systematic review and meta-analysis, we searched MEDLINE, Embase, LILACS, and the Cochrane Central Register o...

  3. Actual Condition of Quality Control of X-ray Imaging System in Primary Care Institution: focused on Gwangju Metropolitan City

    International Nuclear Information System (INIS)

    With the expanded use of radiation in modern medical practices, the most important issue in regards to efforts to reduce individual exposure dose is quality assurance. Therefore in order to study the present condition of quality assurance, the Gwangju Metropolitan City area was divided into five districts each containing ten hospitals. Four experiments were conducted: a reproducibility experiment for kVp, mA, and examination time (sec) intensity of illumination; half-value layer (HVL) measurement; and beam perpendicularity test matching experiment. The tube voltage reproducibility experiment for all fifty hospitals resulted in a 95.33% passing rate and mA and examination time both resulted in a 77.0% passing rate. The passing rate for intensity of illumination was 86.0% and 52.0% for HVL, which was the lowest passing rate of all four factors. For the beam perpendicularity test matching experiment, generally the central flux is matched to within 1.5.deg. . Of all fifty hospitals 30.0% were beyond 3.deg. . The results of the survey showed that 58% responded that they knew about quality assurance cycle. All fifty respondents stated that they have not received any training in regards to quality assurance at their current place of employment. Although quality assurance is making relative progress, the most urgent issue is awareness of the importance of quality assurance. Therefore, the implementation of professional training focusing on safety management and accurate quality assurance of radiation will reduce the exposure to radiation for radiologists and patients and higher quality imaging using less dosage will also be possible

  4. Sensitivity of a third generation wave model to wind and boundary condition sources and model physics: A case study from the South Atlantic Ocean off Brazil coast

    Science.gov (United States)

    Siadatmousavi, S. Mostafa; Jose, Felix; Miot da Silva, Graziela

    2016-05-01

    Three different packages describing the white capping dissipation process, and the corresponding energy input from wind to wave were used to study the surface wave dynamics in South Atlantic Ocean, close to the Brazilian coast. A host of statistical parameters were computed to evaluate the performance of wave model in terms of simulated bulk wave parameters. Wave measurements from a buoy deployed off Santa Catarina Island, Southern Brazil and data along the tracks of Synthetic Aperture Radars were compared with simulated bulk wave parameters; especially significant wave height, for skill assessment of different packages. It has been shown that using a single parameter representing the performance of source and sink terms in the wave model, or relying on data from only one period of simulations for model validation and skill assessment would be misleading. The model sensitivity to input parameters such as time step and grid size were addressed using multiple datasets. The wind data used for the simulation were obtained from two different sources, and provided the opportunity to evaluate the importance of input data quality. The wind speed extracted from remote sensing satellites was compared to wind datasets used for wave modeling. The simulation results showed that the wind quality and its spatial resolution is highly correlated to the quality of model output. Two different sources of wave information along the open boundaries of the model domain were used for skill assessment of a high resolution wave model for the study area. It has been shown, based on the sensitivity analysis, that the effect of using different boundary conditions would decrease as the distance from the open boundary increases; however, the difference were still noticeable at the buoy location which was located 200-300 km away from the model boundaries; but restricted to the narrow band of the low frequency wave spectrum.

  5. Regional climate simulations over South America: sensitivity to model physics and to the treatment of lateral boundary conditions using the MM5 model

    Energy Technology Data Exchange (ETDEWEB)

    Solman, Silvina A. [CONICET-UBA, Centro de Investigaciones del Mar y la Atmosfera (CIMA), Buenos Aires (Argentina); Universidad de Buenos Aires, Departamento de Ciencias de la Atmosfera y los Oceanos. Facultad de Ciencias Exactas y Naturales, Buenos Aires (Argentina); Pessacg, Natalia L. [CONICET-UBA, Centro de Investigaciones del Mar y la Atmosfera (CIMA), Buenos Aires (Argentina)

    2012-01-15

    In this study the capability of the MM5 model in simulating the main mode of intraseasonal variability during the warm season over South America is evaluated through a series of sensitivity experiments. Several 3-month simulations nested into ERA40 reanalysis were carried out using different cumulus schemes and planetary boundary layer schemes in an attempt to define the optimal combination of physical parameterizations for simulating alternating wet and dry conditions over La Plata Basin (LPB) and the South Atlantic Convergence Zone regions, respectively. The results were compared with different observational datasets and model evaluation was performed taking into account the spatial distribution of monthly precipitation and daily statistics of precipitation over the target regions. Though every experiment was able to capture the contrasting behavior of the precipitation during the simulated period, precipitation was largely underestimated particularly over the LPB region, mainly due to a misrepresentation in the moisture flux convergence. Experiments using grid nudging of the winds above the planetary boundary layer showed a better performance compared with those in which no constrains were imposed to the regional circulation within the model domain. Overall, no single experiment was found to perform the best over the entire domain and during the two contrasting months. The experiment that outperforms depends on the area of interest, being the simulation using the Grell (Kain-Fritsch) cumulus scheme in combination with the MRF planetary boundary layer scheme more adequate for subtropical (tropical) latitudes. The ensemble of the sensitivity experiments showed a better performance compared with any individual experiment. (orig.)

  6. Behavior to the fracture of an AISI 304 stainless steel sensitized in BWR reactor conditions (288 degrees Centigrade and 80 Kg/cm2)

    International Nuclear Information System (INIS)

    It is a knew fact that ductility of a lot of structural alloys can be deteriorated by the environment effect which are exposed, and that their consequent embrittlement can put in doubt the safety of their functioning; such is the case of austenitic stainless steels used in internal components of the BWR type reactors which not only is subjected to the effect combined of the aggressive environment which surround it (pressure, temperature, corrosion potential, conductivity medium, local state of efforts, etc.), but also to the action of present neutron radiation, manifesting microstructural changes which are reflected in the augmentation of its susceptibility to the intergranular cracking, phenomena generally known as IASCC ''Irradiation Assisted Stress Corrosion Cracking''. Once appeared the cracking in the material, the useful life of a component is limited by the rapidity to growth of these cracking, making necessary evaluations which can to predict its behavior, therefore the present work shows the preliminary results for determining the behavior to the fracture of an AISI 304 stainless steel sensitized, in a dynamic recirculation circuit which allows to simulate the operation conditions of a BWR reactor (288 Centigrade and 80 kg/cm2). (Author)

  7. Stimuli-Sensitive Hydrogel Based on N-Isopropylacrylamide and Itaconic Acid for Entrapment and Controlled Release of Candida rugosa Lipase under Mild Conditions

    Directory of Open Access Journals (Sweden)

    Nikola Milašinović

    2014-01-01

    Full Text Available Stimuli responsive pH- and temperature-sensitive hydrogel drug delivery systems, as those based on N-isopropylacrylamide (NiPAAm and itaconic acid (IA, have been attracting much of the attention of the scientific community nowadays, especially in the field of drug release. By adjusting comonomer composition, the matrix is enabled to protect the incorporated protein in the highly acidic environment of upper gastrointestinal tract and deliver it in the neutral or slightly basic region of the lower intestine. The protein/poly(NiPAAm-co-IA hydrogels were synthetized by free radical crosslinking copolymerization and were characterized concerning their swelling capability, mechanical properties, and morphology. The pore structure and sizes up to 1.90 nm allowed good entrapment of lipase molecules. Model protein, lipase from Candida rugosa, was entrapped within hydrogels upon mild conditions that provided its protection from harmful environmental influences. The efficiency of the lipase entrapment reached 96.7%, and was dependent on the initial concentration of lipase solution. The swelling of the obtained hydrogels in simulated pH and temperature of gastrointestinal tract, the lipase entrapment efficiency, and its release profiles from hydrogels were investigated as well.

  8. Living conditions and quality of care in residential units for people with long-term mental illness in Portugal – a cross-sectional study

    OpenAIRE

    Cardoso, Graça; Papoila, Ana; Tomé, Gina; Killaspy, Helen; King, Michael; Caldas-de-Almeida, José Miguel

    2016-01-01

    Background As in most European countries, mental health care has shifted from large hospitals to smaller community based settings in Portugal. Our study objectives were to determine: a) the characteristics of users of mental health residential facilities in Portugal; b) the quality of care provided comparing community and hospital units; and c) to investigate associations between quality of care, service and service users’ characteristics and experiences of care. Methods All longer term menta...

  9. North American Virginian Witch Hazel (Hamamelis virginiana): Based Scalp Care and Protection for Sensitive Scalp, Red Scalp, and Scalp Burn-Out

    OpenAIRE

    Trüeb, Ralph M

    2014-01-01

    Background: A sensitive scalp is a frequent problem in daily clinical practice and often represents a major challenge for dermatologists. Objective: The objective was to evaluate the efficacy of a Northamerican Virginian Witch Hazel (Hamamelis virginiana)-based shampoo and tonic (Erol® Energy) for treatment of the sensitive scalp. Methods: Retrospective observational study of male and female patients given Erol® Energy products in the period between August 2010 and December 2013 at the Center...

  10. Sensitivity of East Asian Climate to the Progressive Uplift and Expansion of the Tibetan Plateau Under the Mid-Pliocene Boundary Conditions

    Institute of Scientific and Technical Information of China (English)

    JIANG Dabang; DING Zhongli; Helge DRANGE; GAO Yongqi

    2008-01-01

    A global atmospheric general circulation model has been used to perform eleven idealized numerical experimenta,i.e.,TP00,TPl0,…,TPl00,corresponding to different percentages of the Tibetan Plateau altitude.The aim is to explore the sensitivity of East Asian climate to the uplift and expansion of the Tibetan Plateau under the reconstructed boundary conditions for the mid-Pliocene about 3 Ma ago.When the plateau is progressively uplifted,global annual surface temperature is gradually declined and statistically significant cooling signals emerge only in the Northern Hemisphere,especially over and around the Tibetan Plateau.with larger magnitudes over land than over the oceans.0n the contrary,annual surface temperature rises notably over Central Asia and most parts of Africa,as well as over northeasternmost Eurasia in the experiments TP60 to TP100.Meanwhile.the plateau uplift also leads to annual precipitation augmentation over the Tibetan Plateau but a reduction in northern Asia,the Indian Peninsula,much of Central Asia,parts of western Asia and the southern portions of northeastern Europe.Additionally,it is found that an East Asian summer monsoon system similar to that of the present initially exists in the TP60 and is gradually intensified with the continued plateau uplift.At 850 hPa the plateau uplift induces an anomalous cyclonic circulation around the Tibetan Plateau in summertime and two anomalous westerly currents respectively located to the south and north of the Tibetan Plateau in wintertime.In the mid-troposphere,similar-to-modern spatial pattern of summertime western North Pacific subtropical high is only exhibited in the experiments TP60 to TP100,and the East Asian trough is steadily deepened in response to the progressive uplift and expansion of the Tibetan Plateau.

  11. A new coupled ice sheet/climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke

    2011-03-01

    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  12. A new coupled ice sheet-climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Directory of Open Access Journals (Sweden)

    J. G. Fyke

    2010-08-01

    Full Text Available The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model, that consists of the University of Victoria Earth System Climate Model (UVic ESCM and the Pennsylvania State University Ice model (PSUI. The climate model generates a surface mass balance (SMB field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet.

    A number of simulations for late Holocene, Last Glacial Maximum (LGM, and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  13. A new coupled ice sheet-climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Science.gov (United States)

    Fyke, J. G.; Weaver, A. J.; Pollard, D.; Eby, M.; Carter, L.; Mackintosh, A.

    2010-08-01

    The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model, that consists of the University of Victoria Earth System Climate Model (UVic ESCM) and the Pennsylvania State University Ice model (PSUI). The climate model generates a surface mass balance (SMB) field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT) biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet. A number of simulations for late Holocene, Last Glacial Maximum (LGM), and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  14. A new coupled ice sheet/climate model: description and sensitivity to model physics under Eemian, Last Glacial Maximum, late Holocene and modern climate conditions

    Science.gov (United States)

    Fyke, J. G.; Weaver, A. J.; Pollard, D.; Eby, M.; Carter, L.; Mackintosh, A.

    2011-03-01

    The need to better understand long-term climate/ice sheet feedback loops is motivating efforts to couple ice sheet models into Earth System models which are capable of long-timescale simulations. In this paper we describe a coupled model that consists of the University of Victoria Earth System Climate Model (UVic ESCM) and the Pennsylvania State University Ice model (PSUI). The climate model generates a surface mass balance (SMB) field via a sub-gridded surface energy/moisture balance model that resolves narrow ice sheet ablation zones. The ice model returns revised elevation, surface albedo and ice area fields, plus coastal fluxes of heat and moisture. An arbitrary number of ice sheets can be simulated, each on their own high-resolution grid and each capable of synchronous or asynchronous coupling with the overlying climate model. The model is designed to conserve global heat and moisture. In the process of improving model performance we developed a procedure to account for modelled surface air temperature (SAT) biases within the energy/moisture balance surface model and improved the UVic ESCM snow surface scheme through addition of variable albedos and refreezing over the ice sheet. A number of simulations for late Holocene, Last Glacial Maximum (LGM), and Eemian climate boundary conditions were carried out to explore the sensitivity of the coupled model and identify model configurations that best represented these climate states. The modelled SAT bias was found to play a significant role in long-term ice sheet evolution, as was the effect of refreezing meltwater and surface albedo. The bias-corrected model was able to reasonably capture important aspects of the Antarctic and Greenland ice sheets, including modern SMB and ice distribution. The simulated northern Greenland ice sheet was found to be prone to ice margin retreat at radiative forcings corresponding closely to those of the Eemian or the present-day.

  15. Effect of temperature on the galvanic corrosion of a duplex stainless steel in its sensitized and un-sensitized condition in 992 g/l aqueous LiBr solution

    Energy Technology Data Exchange (ETDEWEB)

    Leiva-Garcia, R.; Munoz-Portero, M.J.; Garcia-Anton, J. [Valencia Univ. Politecnica, Dept. de Ingenieria Quimica y Nuclear. ETSI Industriales, Valencia (Spain)

    2009-07-01

    Corrosion resistance of duplex stainless steels can decrease if, due to an improper heat treatment, the formation of intermetallic phases is induced and local alloying element depletion occurs. The aim of this work is to study the corrosion behaviour of a sensitized and un-sensitized duplex stainless steel (Alloy 900) in 992 g/L aqueous Lithium Bromide solutions at different temperatures (25 C, 50 C, and 75 C). The sensitized sample has been heat treated at 825 C during 1 hour in an inert atmosphere. The sigma phase is observed in the sensitized sample; this phase decreases the corrosion resistance and mechanical properties of Alloy 900. In order to evaluate the different corrosion parameters (open circuit potential (OCP), corrosion potential, pitting potential, re-passivation potential, corrosion current density, passivation current density, and re-passivation current density), cyclic potentiodynamic tests were conducted in the 992 g/L aqueous Lithium Bromide solution using the electro-optical devices P-200002525 y P-200002526. These devices permit the acquisition of images of the electrode surface and electrochemical data simultaneously. The OCP increases with temperature and it is more positive for the sensitized sample. This can be due to morphological changes as a consequence of the heat treatment; the ferrite percentage decreases in the sensitized sample with the used heat treatment. The results show that the corrosion potential increases with temperature and it is more positive in the sensitized sample than for the un-sensitized sample. The pitting potential decreases as a consequence of the temperature and the heat treatment. When the pitting potential drops, the local corrosion resistance decreases. Pit formation is visible on the surface images obtained during the electrochemical tests when the potentiodynamic curve is close to the pitting potential. (authors)

  16. Effect of temperature on the galvanic corrosion of a duplex stainless steel in its sensitized and un-sensitized condition in 992 g/l aqueous LiBr solution

    International Nuclear Information System (INIS)

    Corrosion resistance of duplex stainless steels can decrease if, due to an improper heat treatment, the formation of intermetallic phases is induced and local alloying element depletion occurs. The aim of this work is to study the corrosion behaviour of a sensitized and un-sensitized duplex stainless steel (Alloy 900) in 992 g/L aqueous Lithium Bromide solutions at different temperatures (25 C, 50 C, and 75 C). The sensitized sample has been heat treated at 825 C during 1 hour in an inert atmosphere. The sigma phase is observed in the sensitized sample; this phase decreases the corrosion resistance and mechanical properties of Alloy 900. In order to evaluate the different corrosion parameters (open circuit potential (OCP), corrosion potential, pitting potential, re-passivation potential, corrosion current density, passivation current density, and re-passivation current density), cyclic potentiodynamic tests were conducted in the 992 g/L aqueous Lithium Bromide solution using the electro-optical devices P-200002525 y P-200002526. These devices permit the acquisition of images of the electrode surface and electrochemical data simultaneously. The OCP increases with temperature and it is more positive for the sensitized sample. This can be due to morphological changes as a consequence of the heat treatment; the ferrite percentage decreases in the sensitized sample with the used heat treatment. The results show that the corrosion potential increases with temperature and it is more positive in the sensitized sample than for the un-sensitized sample. The pitting potential decreases as a consequence of the temperature and the heat treatment. When the pitting potential drops, the local corrosion resistance decreases. Pit formation is visible on the surface images obtained during the electrochemical tests when the potentiodynamic curve is close to the pitting potential. (authors)

  17. Pediatric Palliative Care

    OpenAIRE

    Johnston, Donna L.; Hentz, Tracy A.; Friedman, Debra L.

    2005-01-01

    Pediatric palliative care provides benefit to children living with life-threatening or terminal conditions. Palliative care should be available to all seriously ill children. Palliative care includes the treatment of symptoms such as pain, nausea, dyspnea, constipation, anorexia, and sialorrhea. This care can occur in a variety of settings, from home to hospice to hospital, and must include bereavement care and follow up after the death of a child. There are many challenges in pediatric palli...

  18. Understanding the hydrological sensitivity of land use/land management changes to soil and climate conditions across the United Kingdom (Invited)

    Science.gov (United States)

    Holman, I.; Hess, T.

    2013-12-01

    Land use change can fundamentally affect water resources by modifying both evapotranspiration (by changing vegetation properties and growth cycles) and/or the partitioning of flows between runoff and recharge (by modifying soil wetness and soil hydrological properties). This paper describes the application of the WaSim daily soil water balance model to evaluate the sensitivity of the water balance (hydrologically effective precipitation) and flow partitioning (runoff / recharge) to land use and land management change, according to a range of soil characteristics and agroclimatic zones across the United Kingdom. A broad scale modelling framework has been developed, in which WaSim has been used to simulate combinations of soil types (28), landuse (5), soil hydrologic condition (5), drainage (as appropriate) and agroclimate (259) that cover the range of UK environmental conditions. The results have been validated by upscaling the model results to the catchment scale and comparing simulated baseflow indices (BFI) to published estimates of catchment BFI derived using the Hydrology of Soil Types (HOST) classification. The Concordance Correlation Coefficient, which measures how far the values deviate from the concordance (symmetry) line has a high value of 0.83. In addition, the upscaled modelled BFI is within the 95th percentile confidence limits of the catchment BFIs in 885 of 908 catchments. We have simulated the effects of both land use change and land management change on evapotranspiration and recharge in the United Kingdom, in the context of current and future climate. Results show that impacts of land use change, through changing growing season length, crop coefficients and rooting depth, become more apparent in the drier areas of the country (as given by the Potential Soil Moisture Deficit). However, the effect differs according to soil properties, with much greater impacts on soils with high available water content (as given by the difference between Permanent

  19. Sensitivity to grid resolution in the ability of a chemical transport model to simulate observed oxidant chemistry under high-isoprene conditions

    Science.gov (United States)

    Yu, Karen; Jacob, Daniel J.; Fisher, Jenny A.; Kim, Patrick S.; Marais, Eloise A.; Miller, Christopher C.; Travis, Katherine R.; Zhu, Lei; Yantosca, Robert M.; Sulprizio, Melissa P.; Cohen, Ron C.; Dibb, Jack E.; Fried, Alan; Mikoviny, Tomas; Ryerson, Thomas B.; Wennberg, Paul O.; Wisthaler, Armin

    2016-04-01

    Formation of ozone and organic aerosol in continental atmospheres depends on whether isoprene emitted by vegetation is oxidized by the high-NOx pathway (where peroxy radicals react with NO) or by low-NOx pathways (where peroxy radicals react by alternate channels, mostly with HO2). We used mixed layer observations from the SEAC4RS aircraft campaign over the Southeast US to test the ability of the GEOS-Chem chemical transport model at different grid resolutions (0.25° × 0.3125°, 2° × 2.5°, 4° × 5°) to simulate this chemistry under high-isoprene, variable-NOx conditions. Observations of isoprene and NOx over the Southeast US show a negative correlation, reflecting the spatial segregation of emissions; this negative correlation is captured in the model at 0.25° × 0.3125° resolution but not at coarser resolutions. As a result, less isoprene oxidation takes place by the high-NOx pathway in the model at 0.25° × 0.3125° resolution (54 %) than at coarser resolution (59 %). The cumulative probability distribution functions (CDFs) of NOx, isoprene, and ozone concentrations show little difference across model resolutions and good agreement with observations, while formaldehyde is overestimated at coarse resolution because excessive isoprene oxidation takes place by the high-NOx pathway with high formaldehyde yield. The good agreement of simulated and observed concentration variances implies that smaller-scale non-linearities (urban and power plant plumes) are not important on the regional scale. Correlations of simulated vs. observed concentrations do not improve with grid resolution because finer modes of variability are intrinsically more difficult to capture. Higher model resolution leads to decreased conversion of NOx to organic nitrates and increased conversion to nitric acid, with total reactive nitrogen oxides (NOy) changing little across model resolutions. Model concentrations in the lower free troposphere are also insensitive to grid resolution. The

  20. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care Survey

    Directory of Open Access Journals (Sweden)

    Okunseri C

    2013-09-01

    Full Text Available Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC-related emergency department (ED visits are higher during the typical working hours of dental offices and lower during night hours, as well as the associated factors.Methods: We analyzed data from the National Hospital Ambulatory Medical Care Survey for 1997 through 2007 using multivariate binary and polytomous logistic regression adjusted for survey design to determine the effect of predictors on specified outcome variables.Results: Overall, 4,726 observations representing 16.4 million NTDC-related ED visits were identified. Significant differences in rates of NTDC-related ED visits were observed with 40%–50% higher rates during non-working hours and 20% higher rates on weekends than the overall average rate of 170 visits per hour. Compared with 19–33 year olds, subjects <18 years old had significantly higher relative rates of NTDC-related ED visits during nonworking hours [relative rate ratio (RRR = 1.6 to 1.8], whereas those aged 73 and older had lower relative rates during nonworking hours (RRR = 0.4; overall P = 0.0005. Compared with those having private insurance, Medicaid and self-pay patients had significantly lower relative rates of NTDC visits during nonworking and night hours (RRR = 0.6 to 0.7, overall P < 0.0003. Patients with a dental reason for visit were overrepresented during the night hours (RRR = 1.3; overall P = 0.04.Conclusion: NTDC-related visits to ED occurred at a higher rate during non-working hours and on weekends and were significantly associated with age, patient-stated reason for visit and payer type.Keywords: dental

  1. Can a Healthcare “Lean Sweep” Deliver on What Matters to Patients?; Comment on “Improving Wait Times to Care for Individuals with Multimorbidities and Complex Conditions Using Value Stream Mapping”

    Directory of Open Access Journals (Sweden)

    Jennifer Y. Verma

    2015-11-01

    Full Text Available Disconnects and defects in care – such as duplication, poor integration between services or avoidable adverse events – are costly to the health system and potentially harmful to patients and families. For patients living with multiple chronic conditions, such disconnects can be particularly detrimental. Lean is an approach to optimizing value by reducing waste (eg, duplication and defects and containing costs (eg, improving integration of services as well as focusing on what matters to patients. Lean works particularly well to optimize existing processes and services. However, as the burden of chronic illness and frailty overtake episodic care needs, health systems require far greater complex, adaptive change. Such change ought to take into account outcomes in population health in addition to care experiences and costs (together, comprising the Triple Aim; and involve patients and families in co-designing new models of care that better address complex, longer-term health needs.

  2. 42 CFR 418.112 - Condition of participation: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR.

    Science.gov (United States)

    2010-10-01

    ... hospice care to residents of a SNF/NF or ICF/MR. 418.112 Section 418.112 Public Health CENTERS FOR...: Hospices that provide hospice care to residents of a SNF/NF or ICF/MR. In addition to meeting the... of a SNF/NF or ICF/MR must abide by the following additional standards. (a) Standard:...

  3. Understanding the dimensions of intensive care: transpersonal caring and complexity theories.

    Science.gov (United States)

    do Nascimento, Keyla Cristiane; Erdmann, Alacoque Lorenzini

    2009-01-01

    This is a descriptive, interpretive and qualitative study carried out at the ICU of a Brazilian teaching hospital. It aimed to understand the dimensions of human caring experienced by health care professionals, clients and their family members at an ICU, based on human caring complexity. The Transpersonal Caring and Complexity theories support theory and data analysis. The following dimensions of care emerged from the themes analyzed according to Ricoeur: self-care, care as an individual value, professional vs. informal care, care as supportive relationship, affective care, humanized care, care as act/attitude, care practice; educative care, dialogical relationship, care coupled to technology, loving care, interactive care, non-care, care ambience, the essence of life and profession, and meaning/purpose of care. We believe in care that encompasses several dimensions presented here, based on the relationship with the other, on the empathetic, sensitive, affectionate, creative, dynamic and understanding being in the totality of the human being. PMID:19551275

  4. Progressive Care of Obese Patients.

    Science.gov (United States)

    Dambaugh, Lori A; Ecklund, Margaret M

    2016-08-01

    Obese patients have complex needs that complicate their care during hospitalization. These patients often have comorbid conditions, including hypertension, heart failure, obstructive sleep apnea, pressure ulcers, and difficulty with mobility. Obese patients may be well served in the progressive care setting because they may require more intensive nursing care than can be delivered in a general care unit. Progressive care nurses have core competencies that enable them to safely and effectively care for obese patients. A plan of care with interdisciplinary collaboration illustrates the integrative care for obese progressive care patients. (Critical Care Nurse 2016; 36[4]:58-63). PMID:27481802

  5. Common Conditions in Newborns

    Science.gov (United States)

    ... Prenatal Baby Bathing & Skin Care Breastfeeding Crying & Colic Diapers & Clothing Feeding & Nutrition Preemie Sleep Teething & Tooth Care Toddler Preschool Gradeschool Teen Young Adult Healthy Children > Ages & Stages > Baby > Common Conditions in ...

  6. MAGNETIC RESONANCE IMAGING OF INTRACRANIAL INFLAMMATORY CONDITIONS IN DOGS: SENSITIVITY OF SUBTRACTION IMAGES VERSUS PRE- AND POST-GADOLINIUM T1-WEIGHTED IMAGE PAIRS.

    Science.gov (United States)

    Dirrig, Helen; Lamb, Christopher R

    2016-07-01

    Ante mortem diagnosis of canine meningoencephalitis is usually based on the results of neurologic examination, cerebrospinal fluid analysis and magnetic resonance (MR) imaging. It has been hypothesized that subtraction MR imaging may increase the sensitivity of MR for intracranial inflammatory lesions compared to conventional post-gadolinium T1-weighted imaging. Sensitivity of pre- and post-gadolinium (C-/C+) image pairs and dynamic subtraction (DS) images was compared in a retrospective diagnostic accuracy study of 52 dogs with inflammatory cerebrospinal fluid and 67 dogs with idiopathic epilepsy. Series of transverse C-/C+ and DS images were reviewed independently for signs of abnormal enhancement affecting the pachymeninges, leptomeninges or intra-axial structures. Sensitivity of C-/C+ image pairs and DS images was 48% (95% CI: 35-61%) and 65% (95% CI: 52-77%), respectively (P = 0.01). Intra-axial lesions were observed more frequently than meningeal lesions in both C-/C+ (43% vs. 31%) and DS images (61% vs. 22%). The difference in sensitivities of C-/C+ and DS series was entirely due to increased sensitivity of DS images for intra-axial lesions. Eight (12%) dogs with epilepsy had evidence of intra-axial gadolinium accumulation affecting the cerebral cortex in DS images. This finding may represent a false-positive result or a true sign of pathology, possibly associated with a leaky blood-brain barrier in areas of the brain affected by neovascularization secondary to repeated seizures. Results suggest that DS imaging has higher sensitivity than comparison of pre- and post-gadolinium image pairs for inflammatory intra-axial lesions. PMID:27144775

  7. 儿童危重症护理质量敏感性指标评价体系的初步研究%A preliminary study on evaluation system of children’s critical care quality sensitivity index

    Institute of Scientific and Technical Information of China (English)

    张艳红; 张玉侠; 胡静; 顾莺; 刘林霞

    2015-01-01

    Objective:To build a systematic and scientific and sensitive nursing quality evaluation system,so as to promote the continuous improvement of nursing quality in PICU.Methods:A total of 40 pediatric experts in va-rious regions in the whole country were selected by using the Delphi method to conduct two rounds of consulta-tion,And among them,10 high authority of experts were invited for focus group interviews.Results:After two rounds of consultation and expert focus group interview,finally the evaluation system of children’s critical care quality sensitivity index was obtained,including 3 the first level indexes,ten the second level indexes and 34 ter-tiary indicators.Conclusion:The evaluation system of children’s critical care quality sensitivity index was con-structed in preliminary.%[目的]构建一套系统、科学和敏感的护理质量评价体系,以促进儿童重症监护室护理质量的持续改进。[方法]选定全国各地区儿科专家40名,运用德尔菲法进行两轮函询,并邀请其中权威较高的10位专家进行焦点团体访谈。[结果]通过两轮函询以及专家焦点团体访谈后,最终得出儿童危重症护理质量敏感性指标评价体系,包括3个一级指标,10个二级指标,34个三级指标。[结论]初步构建了儿科危重症护理质量敏感性评价指标体系。

  8. Developing cultural sensitivity

    DEFF Research Database (Denmark)

    Ruddock, Heidi; Turner, deSalle

    2007-01-01

    Title. Developing cultural sensitivity: nursing students’ experiences of a study abroad programme Aim. This paper is a report of a study to explore whether having an international learning experience as part of a nursing education programme promoted cultural sensitivity in nursing students...... findings suggest that study abroad is a useful strategy for bridging the theory–practice divide. However, further research is needed with larger and more diverse students to test the generalizability of the findings. Longitudinal research is also needed to assess the impact of study abroad programmes on...... the deliver of culturally sensitive care. Keywords: cultural sensitivity, nursing students, empirical research, report, interviews, study abroad programmes, phenomenology...

  9. Apoplastic ascorbate contributes to the differential ozone sensitivity in two varieties of winter wheat under fully open-air field conditions

    Energy Technology Data Exchange (ETDEWEB)

    Feng Zhaozhong [Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657 (Japan); Pang Jing [Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657 (Japan); Academy of Resource and Environment, Hubei University, Wuhan 430064 (China); Nouchi, Isamu [Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657 (Japan); Kobayashi, Kazuhiko, E-mail: aclasman@mail.ecc.u-tokyo.ac.j [Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657 (Japan); Yamakawa, Takashi [Graduate School of Agricultural and Life Sciences, University of Tokyo, 1-1-1 Yayoi, Bunkyo-ku, Tokyo 113-8657 (Japan); Zhu Jianguo [State Key Laboratory of Soil and Sustainable Agriculture, Institute of Soil Sciences, Chinese Academy of Sciences, Nanjing 210008 (China)

    2010-12-15

    We studied leaf apoplastic ascorbates in relation to ozone (O{sub 3}) sensitivity in two winter wheat (Triticum aestivum L.) varieties: Yangfumai 2 (Y2) and Yangmai 16 (Y16). The plants were exposed to elevated O{sub 3} concentration 27% higher than the ambient O{sub 3} concentration in a fully open-air field from tillering stage until final maturity. The less sensitive variety Y16 had higher concentration of reduced ascorbate in the apoplast and leaf tissue by 33.5% and 12.0%, respectively, than those in the more sensitive variety Y2, whereas no varietal difference was detected in the decline of reduced ascorbate concentration in response to elevated O{sub 3}. No effects of O{sub 3} or variety were detected in either oxidized ascorbate or the redox state of ascorbate in the apoplast and leaf tissue. The lower ascorbate concentrations in both apoplast and leaf tissue should have contributed to the higher O{sub 3} sensitivity in variety Y2. - Apoplastic ascorbate contributes to varietal difference in wheat tolerance to O{sub 3}.

  10. Sensitivity Characteristic Analysis of Adsorbent-Mixed Carbon Nanotube Sensors for the Detection of SF6 Decomposition Products under PD Conditions

    Directory of Open Access Journals (Sweden)

    Ju Tang

    2013-11-01

    Full Text Available Sulfur hexafluoride (SF6 gas decomposition results from the energy produced by partial discharge (PD. The detection of SO2 and H2S content, as important characteristic components of the decomposition products, is significant in the determination of the insulation level of SF6 gas and the inside insulation faults of gas-insulated equipment. A number of gas sensors use carbon nanotubes (CNTs. However, the applications of these sensors are limited by their low intrinsic sensitivity. In this paper, an adsorbent-mixed carbon nanotube gas sensor is proposed to improve the detection of SO2 and H2S concentrations. The sensitivity of adsorbent-mixed carbon nanotube gas sensors to SO2 and H2S at 100 ppm was investigated experimentally. The effect of the mixing ratio on the gas sensitivity characteristic and mechanism of response was also studied. The results show that compared with intrinsic CNTs gas sensors, the gas sensor featuring adsorbent-mixed CNTs has significantly higher sensitivity and responsiveness to SO2 and H2S. The resistance-change rate of SO2 and H2S increased to 33.7% and 50.9% from 0.96% and 12.9%, respectively. Moreover, the resistance-change rate and gas concentration satisfy a linear relationship. The sensor has good repeatability and stability.

  11. Assessment of the radiation sensitivity of patients after conditioning irradiation as preparation for bone marrow or stem cell transplantation; Ermittlung der Strahlenempfindlichkeit bei Patienten nach kondtionierender Bestrahlung zur Vorbereitung einer Knochemarks- bzw. Stammzellentransplantation

    Energy Technology Data Exchange (ETDEWEB)

    Severin, Erhard; Pascher, Elke; Greve, Burkhard; Wedemeyer, Niels; Kienast, Joachim; Willich, Normann; Goehde, Wofgang

    2005-07-01

    The knowledge on the radiation sensitivity of individual patients would allow a better planning of conditioning irradiation including the possibility of dose increase that might enhance the chance of a successful bone marrow or stem cell transplantation. The study was focused on the search of reliable and fast laboratory test procedures to predict the individual radiation sensitivity. Several blood tests were evaluated with respect to their appropriateness: mostly flow-cytometric test on lymphocytes: micronuclei, cell proliferation, apoptosis activation of cytokines and the total number of leucocytes, blood stem cells CD4+ and CD8+ lymphocytes, and a spectro-photometric test of blood plasma for the determination of the antioxidative capacity.

  12. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings – Guideline of the German Society for Hospital Hygiene (DGKH

    Directory of Open Access Journals (Sweden)

    Külpmann, Rüdiger

    2016-02-01

    Full Text Available Since the publication of the first “Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems in hospitals” ( in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section “Ventilation and air conditioning technology” attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care.

  13. Urinary infection in patients of public health care of Campo Mourão-PR, Brazil: bacterial prevalence and sensitivity profile

    Directory of Open Access Journals (Sweden)

    Josiane dos Santos Bitencourt

    2014-10-01

    Full Text Available Introduction: Cases of bacterial resistance in urinary tract infections (UTIs have increased significantly, mainly due to indiscriminate use of antimicrobials. Objective: Objective: To evaluate the prevalence and antimicrobial susceptibility of microorganisms isolated in urine cultures of patients of Consórcio Intermunicipal de Saúde da Comunidade dos Municípios da Região de Campo Mourão (CISCOMCAM clinical laboratory. Method: We performed a retrospective study of data from urine culture and sensitivity done between January 2012 and December 2013. Results: The most prevalent bacteria were Escherichia coli; women were the most affected gender and people 16-45 years, the most affected age group. The sensitivity profile showed that the antimicrobial combination trimethoprim/ sulfamethoxazole was not associated with the highest rate of bacterial resistance (59.7% and the combination of amoxicillin/clavulanic acid showed the lowest resistance rate (15.3%. For most antimicrobials, including ciprofloxacin and norfloxacin, the rates of bacterial resistance have increased from 2012 to 2013 with statistical significance (p < 0.05 in some cases. Discussion: The prevalence of Gram-negative bacilli in urinary infections is due to the fact that intestinal flora is rich in enterobacteria, and women are most affected by anatomical factors. The development of bacterial resistance to antimicrobials probably arises from their indiscriminate use. Conclusion: The rate of microbial resistance has risen, showing the need for a more effective control of antimicrobial use.

  14. Effects of hydrologic conditions on SWAT model performance and parameter sensitivity for a small, mixed land use catchment in New Zealand

    Science.gov (United States)

    Me, W.; Abell, J. M.; Hamilton, D. P.

    2015-10-01

    The Soil Water Assessment Tool (SWAT) was configured for the Puarenga Stream catchment (77 km2), Rotorua, New Zealand. The catchment land use is mostly plantation forest, some of which is spray-irrigated with treated wastewater. A Sequential Uncertainty Fitting (SUFI-2) procedure was used to auto-calibrate unknown parameter values in the SWAT model. Model validation was performed using two data sets: (1) monthly instantaneous measurements of suspended sediment (SS), total phosphorus (TP) and total nitrogen (TN) concentrations; and (2) high-frequency (1-2 h) data measured during rainfall events. Monthly instantaneous TP and TN concentrations were generally not reproduced well (24 % bias for TP, 27 % bias for TN, and R2 0.75) during model validation. Comparison of simulated daily mean SS, TP and TN concentrations with daily mean discharge-weighted high-frequency measurements during storm events indicated that model predictions during the high rainfall period considerably underestimated concentrations of SS (44 % bias) and TP (70 % bias), while TN concentrations were comparable (< 1 % bias; R2 and NSE both ~ 0.5). This comparison highlighted the potential for model error associated with quick flow fluxes in flashy lower-order streams to be underestimated compared with low-frequency (e.g. monthly) measurements derived predominantly from base flow measurements. To address this, we recommend that high-frequency, event-based monitoring data are used to support calibration and validation. Simulated discharge, SS, TP and TN loads were partitioned into two components (base flow and quick flow) based on hydrograph separation. A manual procedure (one-at-a-time sensitivity analysis) was used to quantify parameter sensitivity for the two hydrologically separated regimes. Several SWAT parameters were found to have different sensitivities between base flow and quick flow. Parameters relating to main channel processes were more sensitive for the base flow estimates, while those

  15. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    OpenAIRE

    Montaldo, N.; Toninelli, V.; Albertson, J. D.; Mancini, M.; P. A. Troch

    2003-01-01

    Recent developments have made land-surface models (LSMs) more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps), a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity) using the TOPLATS model, an ex...

  16. The acute and sensitization effects of tumor necrosis factor-α: implications for immunotherapy as well as psychiatric and neurological conditions.

    Science.gov (United States)

    Hayley, Shawn; Merali, Zul; Anisman, Hymie

    2002-12-01

    In addition to their role as signaling molecules of the immune system, cytokines may participate in central neurotransmission. Variations of the central and/or peripheral levels of the proinflammatory cytokines, tumor necrosis factor-α (TNF-α) and interleukin-β (IL-1β), impact on neuroendocrine processes as well as central neurotransmitter activity. To a considerable extent, these effects are reminiscent of those elicited by psychogenic stressors. The current review describes recent findings consistent with a role for these cytokines in the neurochemical and behavioral manifestations of clinical depression, as well as the cellular death associated with cerebral ischemia. Moreover, the increasing use of cytokines in the immunotherapeutic treatment of various autoimmune diseases (e.g. rheumatoid arthritis) and cancers prompted us to consider the potential role of central processes in subserving the mood-related side-effects elicited by these treatments. Finally, a single administration of TNF-α has been shown to elicit a time-dependent sensitization effect, wherein the behavioral and neurochemical responses elicited by later cytokine treatment are greatly enhanced. Thus, particular attention was devoted to the possibility that elevated levels of TNF-α, through either exogenous (e.g. immunotherapy) or endogenous (e.g. brain damage or stressors) means may sensitize neurotransmitter or second messenger pathways important for the pathology. Given the time-dependent nature of cytokine sensitization effects, the schedule of cytokine administration during immunotherapy, or the timing of cytokine up-regulation in response to traumatic or stressful events may favor the development of sensitized central processes, which may influence clinical outcome. PMID:26984578

  17. The effect of background hydrometeorological conditions on the sensitivity of evapotranspiration to model parameters: analysis with measurements from an Italian alpine catchment

    OpenAIRE

    Montaldo, N.; Toninelli, V.; Albertson, J.D.; Mancini, M.; Troch, P.A.

    2003-01-01

    Recent developments have made land-surface models (LSMs) more complex through the inclusion of more processes and controlling variables, increasing numbers of parameters and uncertainty in their estimates. To overcome these uncertainties, prior to applying a distributed LSM over the whole Toce basin (Italian Alps), a field campaign was carried out at an experimental plot within the basin before exploring the skill and parameter importance (sensitivity) using the TOPLATS model, an existing LSM...

  18. Using a Modified Soil-Plant-Atmosphere Scheme (MSPAS) to Study the Sensitivity of Land Surface and Boundary Layer Processes to Soil and Vegetation Conditions

    Institute of Scientific and Technical Information of China (English)

    刘树华; 乐旭; 刘辉志; 胡非

    2004-01-01

    A series of sensitivity tests are performed to test the stability and sensibility of the Modified Soil-PlantAtmosphere Scheme (MSPAS), which was wholly introduced in a previous paper. The numerical simulation results from the experiments show good agreement with physical reality. Besides, some of the results are illuminating. Together with the first paper, it is concluded that MSPAS is a simple but effective model,and it is practically valuable in the research work of desertification control and reforestation in China

  19. Variations in corticosteroid/anesthetic injections for painful shoulder conditions: comparisons among orthopaedic surgeons, rheumatologists, and physical medicine and primary-care physicians

    Directory of Open Access Journals (Sweden)

    Skedros John G

    2007-07-01

    Full Text Available Abstract Background Variations in corticosteroid/anesthetic doses for injecting shoulder conditions were examined among orthopaedic surgeons, rheumatologists, and primary-care sports medicine (PCSMs and physical medicine and rehabilitation (PMRs physicians to provide data needed for documenting inter-group differences for establishing uniform injection guidelines. Methods 264 surveys, sent to these physicians in our tri-state area of the western United States, addressed corticosteroid/anesthetic doses and types used for subacromial impingement, degenerative glenohumeral and acromioclavicular arthritis, biceps tendinitis, and peri-scapular trigger points. They were asked about preferences regarding: 1 fluorinated vs. non-fluorinated corticosteroids, 2 acetate vs. phosphate types, 3 patient age, and 4 adjustments for special considerations including young athletes and diabetics. Results 169 (64% response rate, RR surveys were returned: 105/163 orthopaedic surgeons (64%RR, 44/77 PCSMs/PMRs (57%RR, 20/24 rheumatologists (83%RR. Although corticosteroid doses do not differ significantly between specialties (p > 0.3, anesthetic volumes show broad variations, with surgeons using larger volumes. Although 29% of PCSMs/PMRs, 44% rheumatologists, and 41% surgeons exceed "recommended" doses for the acromioclavicular joint, >98% were within recommendations for the subacromial bursa and glenohumeral joint. Depo-Medrol® (methylprednisolone acetate and Kenalog® (triamcinolone acetonide are most commonly used. More rheumatologists (80% were aware that there are acetate and phosphate types of corticosteroids as compared to PCSMs/PMRs (76% and orthopaedists (60%. However, relatively fewer rheumatologists (25% than PCSMs/PMRs (32% or orthopaedists (32% knew that phosphate types are more soluble. Fluorinated corticosteroids, which can be deleterious to soft tissues, were used with these frequencies for the biceps sheath: 17% rheumatologists, 8% PCSMs/PMRs, 37

  20. Nitrogen-detected TROSY yields comparable sensitivity to proton-detected TROSY for non-deuterated, large proteins under physiological salt conditions

    International Nuclear Information System (INIS)

    Direct detection of the TROSY component of proton-attached 15N nuclei (15N-detected TROSY) yields high quality spectra with high field magnets, by taking advantage of the slow 15N transverse relaxation. The slow transverse relaxation and narrow line width of the 15N-detected TROSY resonances are expected to compensate for the inherently low 15N sensitivity. However, the sensitivity of 15N-detected TROSY in a previous report was one-order of magnitude lower than in the conventional 1H-detected version. This could be due to the fact that the previous experiments were performed at low salt (0–50 mM), which is advantageous for 1H-detected experiments. Here, we show that the sensitivity gap between 15N and 1H becomes marginal for a non-deuterated, large protein (τc = 35 ns) at a physiological salt concentration (200 mM). This effect is due to the high salt tolerance of the 15N-detected TROSY. Together with the previously reported benefits of the 15N-detected TROSY, our results provide further support for the significance of this experiment for structural studies of macromolecules when using high field magnets near and above 1 GHz

  1. Nitrogen-detected TROSY yields comparable sensitivity to proton-detected TROSY for non-deuterated, large proteins under physiological salt conditions

    Energy Technology Data Exchange (ETDEWEB)

    Takeuchi, Koh [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan); Arthanari, Haribabu [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Imai, Misaki [Japan Biological Informatics Consortium, Research and Development Department (Japan); Wagner, Gerhard, E-mail: gerhard-wagner@hms.harvard.edu [Harvard Medical School, Department of Biochemistry and Molecular Pharmacology (United States); Shimada, Ichio, E-mail: shimada@iw-nmr.f.u-tokyo.ac.jp [National Institute for Advanced Industrial Science and Technology, Molecular Profiling Research Center for Drug Discovery (Japan)

    2016-02-15

    Direct detection of the TROSY component of proton-attached {sup 15}N nuclei ({sup 15}N-detected TROSY) yields high quality spectra with high field magnets, by taking advantage of the slow {sup 15}N transverse relaxation. The slow transverse relaxation and narrow line width of the {sup 15}N-detected TROSY resonances are expected to compensate for the inherently low {sup 15}N sensitivity. However, the sensitivity of {sup 15}N-detected TROSY in a previous report was one-order of magnitude lower than in the conventional {sup 1}H-detected version. This could be due to the fact that the previous experiments were performed at low salt (0–50 mM), which is advantageous for {sup 1}H-detected experiments. Here, we show that the sensitivity gap between {sup 15}N and {sup 1}H becomes marginal for a non-deuterated, large protein (τ{sub c} = 35 ns) at a physiological salt concentration (200 mM). This effect is due to the high salt tolerance of the {sup 15}N-detected TROSY. Together with the previously reported benefits of the {sup 15}N-detected TROSY, our results provide further support for the significance of this experiment for structural studies of macromolecules when using high field magnets near and above 1 GHz.

  2. A cluster randomised controlled trial of the clinical and cost-effectiveness of a 'whole systems' model of self-management support for the management of long- term conditions in primary care: trial protocol

    Directory of Open Access Journals (Sweden)

    Bower Peter

    2012-01-01

    Full Text Available Abstract Background Patients with long-term conditions are increasingly the focus of quality improvement activities in health services to reduce the impact of these conditions on quality of life and to reduce the burden on care utilisation. There is significant interest in the potential for self-management support to improve health and reduce utilisation in these patient populations, but little consensus concerning the optimal model that would best provide such support. We describe the implementation and evaluation of self-management support through an evidence-based 'whole systems' model involving patient support, training for primary care teams, and service re-organisation, all integrated into routine delivery within primary care. Methods The evaluation involves a large-scale, multi-site study of the implementation, effectiveness, and cost-effectiveness of this model of self-management support using a cluster randomised controlled trial in patients with three long-term conditions of diabetes, chronic obstructive pulmonary disease (COPD, and irritable bowel syndrome (IBS. The outcome measures include healthcare utilisation and quality of life. We describe the methods of the cluster randomised trial. Discussion If the 'whole systems' model proves effective and cost-effective, it will provide decision-makers with a model for the delivery of self-management support for populations with long-term conditions that can be implemented widely to maximise 'reach' across the wider patient population. Trial registration number ISRCTN: ISRCTN90940049

  3. Molecular typing of toxic shock syndrome toxin-1- and Enterotoxin A-producing methicillin-sensitive Staphylococcus aureus isolates from an outbreak in a neonatal intensive care unit.

    Science.gov (United States)

    Layer, Franziska; Sanchini, Andrea; Strommenger, Birgit; Cuny, Christiane; Breier, Ann-Christin; Proquitté, Hans; Bührer, Christoph; Schenkel, Karl; Bätzing-Feigenbaum, Jörg; Greutelaers, Benedikt; Nübel, Ulrich; Gastmeier, Petra; Eckmanns, Tim; Werner, Guido

    2015-10-01

    Outbreaks of Staphylococcus aureus are common in neonatal intensive care units (NICUs). Usually they are documented for methicillin-resistant strains, while reports involving methicillin-susceptible S. aureus (MSSA) strains are rare. In this study we report the epidemiological and molecular investigation of an MSSA outbreak in a NICU among preterm neonates. Infection control measures and interventions were commissioned by the Local Public Health Authority and supported by the Robert Koch Institute. To support epidemiological investigations molecular typing was done by spa-typing and Multilocus sequence typing; the relatedness of collected isolates was further elucidated by DNA SmaI-macrorestriction, microarray analysis and bacterial whole genome sequencing. A total of 213 neonates, 123 healthcare workers and 205 neonate parents were analyzed in the period November 2011 to November 2012. The outbreak strain was characterized as a MSSA spa-type t021, able to produce toxic shock syndrome toxin-1 and Enterotoxin A. We identified seventeen neonates (of which two died from toxic shock syndrome), four healthcare workers and three parents putatively involved in the outbreak. Whole-genome sequencing permitted to exclude unrelated cases from the outbreak and to discuss the role of healthcare workers as a reservoir of S. aureus on the NICU. Genome comparisons also indicated the presence of the respective clone on the ward months before the first colonized/infected neonates were detected. PMID:26321006

  4. Impact of chemical and meteorological boundary and initial conditions on air quality modeling: WRF-Chem sensitivity evaluation for a European domain

    Science.gov (United States)

    Ritter, Mathias; Müller, Mathias D.; Jorba, Oriol; Parlow, Eberhard; Liu, L.-J. Sally

    2013-01-01

    This study evaluates the impact of different chemical and meteorological boundary and initial conditions on the state-of-the-art Weather Research and Forecasting (WRF) model with its chemistry extension (WRF-Chem). The evaluation is done for July 2005 with 50 km horizontal resolution. The effect of monthly mean chemical boundary conditions derived from the chemical transport model LMDZ-INCA on WRF-Chem is evaluated against the effect of the preset idealized profiles. Likewise, the impact of different meteorological initial and boundary conditions (GFS and Reanalysis II) on the model is evaluated. Pearson correlation coefficient between these different runs range from 0.96 to 1.00. Exceptions exists for chemical boundary conditions on ozone and for meteorological boundary conditions on PM10, where coefficients of 0.90 were obtained. Best results were achieved with boundary and initial conditions from LMDZ-INCA and GFS. Overall, the European simulations show encouraging results for observed air pollutant, with ozone being the most and PM10 being the least satisfying.

  5. Abscisic Acid and Cytokinin-Induced Osmotic and Antioxidant Regulation in Two Drought-Tolerant and Drought-Sensitive Cultivars of Wheat During Grain Filling Under Water Deficit in Field Conditions

    OpenAIRE

    2014-01-01

    Phytohormones play critical roles in regulating plant responses to stress. The present study investigates the effect of cytokinin, abscisic acid and cytokinin/abscisic acid interaction on some osmoprotectants and antioxidant parameters induced by drought stress in two wheat cultivars (Triticum aestivum L.) of ‘Pishgam’ and ‘MV-17’ as tolerant and sensitive to drought during post-anthesis phase, respectively grown in field conditions. The most considerable effect of the treatments was exhibite...

  6. Characterization of the burning conditions of archaeological pebbles using the thermal sensitization of the 110 °C TL peak of quartz

    International Nuclear Information System (INIS)

    The 110 °C TL glow peak of quartz has been used in dating and retrospective dosimetry due to the pre-dose effect and the sensitivity changes caused by heating. One of the main difficulties related to TL dating is the sureness that the geological signal was completely zeroed by firing. In this study, the sensitivity change of the 110 °C peak and the EPR signal intensity of the E1′ center were combined to account for the burning status of archaeological pebbles. For this, a quartz pebble was sawn into many pieces and each piece was heat-treated at different temperatures from 200 to 800 °C. Powdered aliquots were γ-irradiated and stored into an ice-bath before the TL readout. Peak-maximum temperature, TL intensity and activation energy of the 110 °C peak were determined by glow curve deconvolution methods. The thermal activation characteristic obtained in this study showed a peak maximum at 500 °C and a sensitization ratio higher than 200. The heating temperature also affected the intensity of the E1′ center. The usefulness of the burning pattern was tested by measuring the TL and EPR signals of several archaeological pebbles, initially classified as “burnt”, “unburnt” or “unidentified”, and also from two specimens burnt in a campfire. The main achievement of this study was the possibility to infer the temperature in which a pebble was heated in the past independent of visual signs. - Highlights: • Quartz 110 °C TL peak and E1′ EPR signal were measured in burnt and unburnt pebbles. • TAC of quartz pebbles from Boqueirão da Pedra Furada shelter was shown. • A pattern to estimate the burning temperature of archaeological pebbles was proposed

  7. Risk-factors for stress-related absence among health care employees: a bio-psychosocial perspective. Associations between self-rated health, working conditions and biological stress hormones

    Directory of Open Access Journals (Sweden)

    Ann-Sophie Hansson

    2006-12-01

    Full Text Available

    Background: Stress is a major cause of sickness absence and the health care sector appears to be especially at risk. This cross sectional study aimed to identify the risk factors for absence due to self-reported stress among health care employees. Methods: 225 health care employees were categorized into two groups based on presence or not of self-rated sickness absence for stress. Questionnaire data and stress sensitive hormones measurements were used.

    Results: Employees with stress related sick leave experienced worse health, poorer work satisfaction as well as worse social and home situations than those employees without stress-related sick leave. No-significant differences were identified regarding stress-sensitive hormones. The risk for employees, not satisfied at work, of becoming absent due to stress was approximately three fold compared to those who reported being satisfied (OR 2.8, 95% confidence interval; (CI 1.3 - 5.9. For those not satisfied with their social situation, the risk for sickness absence appeared to be somewhat higher (OR 3.2; CI 1.2 - 8.6. Individual factors such as recovery potential and meaning of life as well as work related factors such as skill development and work tempo predicted employee’ s work satisfaction.

    Conclusions: Based on cross sectional data, work-site and individual factors as well as social situations appear to increase the risk for absence due to stress among health care employees. Lower recovery potential, higher work tempo and poor leadership appeared to be related to the high degree of work related exhaustion experienced by employees.

  8. Characterization and sensitivity to antibiotics of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units

    Directory of Open Access Journals (Sweden)

    Manuel Medell

    2012-02-01

    Full Text Available OBJECTIVE: This observational study described the characterization of bacteria isolated from the lower respiratory tract of ventilated patients hospitalized in intensive care units. The demonstration of isolated microorganism resistance to antibiotics and a time-trend analysis of infection comparing a 48-month period were also other objectives. METHOD: Semi-quantitative assays of 1254 samples taken from 741 ventilated patients were performed, while pathogens were identified using the Enterotube II assay and VITEK 2 Compact equipment. Bacterial resistance to antibiotics was assessed by the Kirby-Bauer disc diffusion method and time-trend analysis of infection was based on data recorded by hospital microbiology laboratories. RESULTS: The most prevalent isolated bacteria from the patient's lower respiratory tract were with Gram-negative bacteria (67.8% mostly represented by: Acinetobacter spp. (25.2%, Pseudomonas spp. (18.3% and Klebsiellas spp. (9.4%. Acinetobacter spp. showed moderate high to very high resistance to ceftriaxone (CRO, gentamicin (CN, amikacin (AK, meropenem (MRP, aztreonam (ATM and piperacillin/tazobactam (TZP. Some isolates of Acinetobacter spp. resistant to colistin (CS were identified in this patient population. Pseudomonas spp. and Klebsiella spp. were very highly resistant to ampicillin/sublactam (AMS and with moderate or low resistance to CRO, ATM, MRP, AK, CN and TZP. A decrease in the Pseudomonas spp. prevalence rate was observed, whereas an increase in Acinetobacter spp. and Klebsiella spp. prevalence rates were observed in a 48-month period. CONCLUSION: This research corroborated that these nosocomial infections are a relevant medical problem in our context. The most prevalent bacterial infections in the lower respiratory tract of ventilated patients were by Acinetobacter spp., Pseudomonas spp. and Klebsiella spp. The panel of antibiotics used as preventive therapy was not the solution of infections and probably induced

  9. Mutation in the bimD gene of Aspergillus nidulans confers a conditional mitotic block and sensitivity to DNA damaging agents

    International Nuclear Information System (INIS)

    Mutation in the bimD gene of Aspergillus nidulans results in a mitotic block in anaphase characterized by a defective mitosis. Mutation in bimD also confers, at temperatures permissive for the mitotic arrest phenotype, an increased sensitivity to DNA damaging agents, including methyl methanesulfonate and ultraviolet light. In order to better understand the relationship between DNA damage and mitotic progression, the authors cloned the bimD gene from Aspergillus. A cosmid containing the bimD gene was identified among pools of cosmids by cotransformation with the nutritional selective pyrG gene of a strain carrying the recessive, temperature-sensitive lethal bimD6 mutation. The bimD gene encodes a predicted polypeptide of 166,000 daltons in mass and contains amino acid sequence motifs similar to those found in some DNA-binding transcription factors. These sequences include a basic domain followed by a leucine zipper, which together are called a bZIP motif, and a carboxyl-terminal domain enriched in acidic amino acids. Overexpression of the wild-type bimD protein resulted in an arrest of the nuclear division cycle that was reversible and determined to be in either the G1 or S phase of the cell cycle. The data suggest that bimD may play an essential regulatory role relating to DNA metabolism which is required for a successful mitosis. 7l refs., 7 figs., 1 tab

  10. Competence of birth attendants at providing emergency obstetric care under India’s JSY conditional cash transfer program for institutional delivery: an assessment using case vignettes in Madhya Pradesh province

    OpenAIRE

    Chaturvedi, Sarika; Upadhyay, Sourabh; De Costa, Ayesha

    2014-01-01

    Background Access to emergency obstetric care by competent staff can reduce maternal mortality. India has launched the Janani Suraksha Yojana (JSY) conditional cash transfer program to promote institutional births. During implementation of the JSY, India witnessed a steep increase in the proportion of institutional deliveries-from 40% in 2004 to 73% in 2012. However, maternal mortality reduction follows a secular trend. Competent management of complications, when women deliver in facilities u...

  11. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity

    Science.gov (United States)

    Emerson, Natacha D.; Morrell, Holly E. R.; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent…

  12. The Milankovitch theory and climate sensitivity. I - Equilibrium climate model solutions for the present surface conditions. II - Interaction between the Northern Hemisphere ice sheets and the climate system

    Science.gov (United States)

    Neeman, Binyamin U.; Ohring, George; Joseph, Joachim H.

    1988-01-01

    A seasonal climate model was developed to test the climate sensitivity and, in particular, the Milankovitch (1941) theory. Four climate model versions were implemented to investigate the range of uncertainty in the parameterizations of three basic feedback mechanisms: the ice albedo-temperature, the outgoing long-wave radiation-temperature, and the eddy transport-meridional temperature gradient. It was found that the differences between the simulation of the present climate by the four versions were generally small, especially for annually averaged results. The climate model was also used to study the effect of growing/shrinking of a continental ice sheet, bedrock sinking/uplifting, and sea level changes on the climate system, taking also into account the feedback effects on the climate of the building of the ice caps.

  13. High-sensitivity nuclear magnetic resonance at Giga-Pascal pressures: a new tool for probing electronic and chemical properties of condensed matter under extreme conditions.

    Science.gov (United States)

    Meier, Thomas; Haase, Jürgen

    2014-01-01

    Nuclear Magnetic Resonance (NMR) is one of the most important techniques for the study of condensed matter systems, their chemical structure, and their electronic properties. The application of high pressure enables one to synthesize new materials, but the response of known materials to high pressure is a very useful tool for studying their electronic structure and developing theories. For example, high-pressure synthesis might be at the origin of life; and understanding the behavior of small molecules under extreme pressure will tell us more about fundamental processes in our universe. It is no wonder that there has always been great interest in having NMR available at high pressures. Unfortunately, the desired pressures are often well into the Giga-Pascal (GPa) range and require special anvil cell devices where only very small, secluded volumes are available. This has restricted the use of NMR almost entirely in the past, and only recently, a new approach to high-sensitivity GPa NMR, which has a resonating micro-coil inside the sample chamber, was put forward. This approach enables us to achieve high sensitivity with experiments that bring the power of NMR to Giga-Pascal pressure condensed matter research. First applications, the detection of a topological electronic transition in ordinary aluminum metal and the closing of the pseudo-gap in high-temperature superconductivity, show the power of such an approach. Meanwhile, the range of achievable pressures was increased tremendously with a new generation of anvil cells (up to 10.1 GPa), that fit standard-bore NMR magnets. This approach might become a new, important tool for the investigation of many condensed matter systems, in chemistry, geochemistry, and in physics, since we can now watch structural changes with the eyes of a very versatile probe. PMID:25350694

  14. Radio-sensitization effect of an mTOR inhibitor, temsirolimus, on lung adenocarcinoma A549 cells under normoxic and hypoxic conditions

    International Nuclear Information System (INIS)

    The mammalian target of rapamycin (mTOR) correlates with cell survival under hypoxia and regulates hypoxia-inducible factor-1α (HIF-1α), a key protein in hypoxia-related events. However, the role of mTOR in radio-resistance has not been fully investigated. Therefore, the effect of mTOR on the radio-resistance of cancer cells under hypoxia was evaluated using the mTOR inhibitor temsirolimus. Clonogenic survival was examined in the A549 human lung adenocarcinoma cell line under normoxia or hypoxia, with or without temsirolimus. An oxygen enhancement ratio (OER) was calculated using the D10 values, the doses giving 10% survival. Western blotting was performed to investigate the effect of temsirolimus on mTOR and the HIF-1α pathway under normoxia and hypoxia. A549 cells showed a radio-resistance of 5.1 and 14.2 Gy, as indicated by D10 values under normoxia and hypoxia, respectively; the OER was 2.8. The cell survival rates under hypoxia and with temsirolimus remarkably decreased compared with those under normoxia. The D10 values of the cells under normoxia and hypoxia were 4.8 and 5.4 Gy, respectively (OER = 1.1). mTOR expression was suppressed by temsirolimus under both normoxia and hypoxia. HIF-1α expression decreased under hypoxia in the presence of temsirolimus. These results suggest that temsirolimus can overcome the radio-resistance induced by hypoxia. When the fact that mTOR acts upstream of HIF-1α is considered, our data suggest that the restoration of radiation sensitivity by temsirolimus under hypoxia may be associated with the suppression of the HIF-1α pathway. Temsirolimus could therefore be used as a hypoxic cell radio-sensitizer. (author)

  15. Fast and highly sensitive fiber-enhanced Raman spectroscopic monitoring of molecular H2 and CH4 for point-of-care diagnosis of malabsorption disorders in exhaled human breath.

    Science.gov (United States)

    Hanf, Stefan; Bögözi, Timea; Keiner, Robert; Frosch, Torsten; Popp, Jürgen

    2015-01-20

    Breath gas analysis is a novel powerful technique for noninvasive, early-stage diagnosis of metabolic disorders or diseases. Molecular hydrogen and methane are biomarkers for colonic fermentation, because of malabsorption of oligosaccharides (e.g., lactose or fructose) and for small intestinal bacterial overgrowth. Recently, the presence of these gases in exhaled breath was also correlated with obesity. Here, we report on the highly selective and sensitive detection of molecular hydrogen and methane within a complex gas mixture (consisting of H2, CH4, N2, O2, and CO2) by means of fiber-enhanced Raman spectroscopy (FERS). An elaborate FERS setup with a microstructured hollow core photonic crystal fiber (HCPCF) provided a highly improved analytical sensitivity. The simultaneous monitoring of H2 with all other gases was achieved by a combination of rotational (H2) and vibrational (other gases) Raman spectroscopy within the limited spectral transmission range of the HCPCF. The HCPCF was combined with an adjustable image-plane aperture pinhole, in order to separate the H2 rotational Raman bands from the silica background signal and improve the sensitivity down to a limit of detection (LOD) of 4.7 ppm (for only 26 fmol H2). The ability to monitor the levels of H2 and CH4 in a positive hydrogen breath test (HBT) was demonstrated. The FERS sensor possesses a high dynamic range (∼5 orders of magnitude) with a fast response time of few seconds and provides great potential for miniaturization. We foresee that this technique will pave the way for fast, noninvasive, and painless point-of-care diagnosis of metabolic diseases in exhaled human breath. PMID:25545503

  16. High-sensitive cardiac Troponin T is superior to echocardiography in predicting 1-year mortality in patients with SIRS and shock in intensive care

    Directory of Open Access Journals (Sweden)

    Bergenzaun Lill

    2012-09-01

    Full Text Available Abstract Background Left ventricular (LV dysfunction is well documented in the critically ill. We assessed 1-year mortality in relation to cardiac biomarkers and LV function parameters by echocardiography in patients with shock. Methods A prospective, observational, cohort study of 49 patients. B-natriuretic peptide (BNP, high-sensitive troponin T (hsTNT and transthoracic echocardiography (TTE were assessed within 12 h of study inclusion. LV systolic function was measured by ejection fraction (LVEF, mean atrioventricular plane displacement (AVPDm, peak systolic tissue Doppler velocity imaging (TDIs and velocity time integral in the LV outflow tract (LVOT VTI. LV diastolic function was evaluated by transmitral pulsed Doppler (E, A, E/A, E-deceleration time, tissue Doppler indices (é, á, E/é and left atrial volume (La volume. APACHE II (Acute Physiology and Chronic Health Evaluation and SOFA (Sequential Organ Failure Assessment scores were calculated. Results hsTNT was significantly higher in non-survivors than in survivors (60 [17.0-99.5] vs 168 [89.8-358] ng/l, p = 0.003. Other univariate predictors of mortality were APACHE II (p = 0.009, E/é (p = 0.023, SOFA (p = 0.024 and age (p = 0.031. Survivors and non-survivors did not differ regarding BNP (p = 0.26 or any LV systolic function parameter (LVEF p = 0.87, AVPDm p = 0.087, TDIs p = 0.93, LVOT VTI p = 0.18. Multivariable logistic regression analysis identified hsTNT (p = 0.010 as the only independent predictor of 1-year mortality; adjusted odds ratio 2.0 (95% CI 1.2- 3.5. Conclusions hsTNT was the only independent predictor of 1-year mortality in patients with shock. Neither BNP nor echocardiographic parameters had an independent prognostic value. Further studies are needed to establish the clinical significance of elevated hsTNT in patients in shock.

  17. Sensitivity of Eisenia andrei (Annelida, Oligochaeta) to a commercial formulation of abamectin in avoidance tests with artificial substrate and natural soil under tropical conditions.

    Science.gov (United States)

    Nunes, Maria Edna Tenório; Espíndola, Evaldo Luiz Gaeta

    2012-05-01

    Obtaining ecotoxicological data on pesticides in tropical regions is imperative for performing more realistic risk analysis, and avoidance tests have been proposed as a useful, fast and cost-effective tool. Therefore, the present study aimed to evaluate the avoidance behavior of Eisenia andrei to a formulated product, Vertimec® 18 EC (a.i abamectin), in tests performed on a reference tropical artificial soil (TAS), to derive ecotoxicological data on tropical conditions, and a natural soil (NS), simulating crop field conditions. In TAS tests an adaptation of the substrate recommended by OECD and ISO protocols was used, with residues of coconut fiber as a source of organic matter. Concentrations of the pesticide on TAS test ranged from 0 to 7 mg abamectin/kg (dry weight-d.w.). In NS tests, earthworms were exposed to samples of soils sprayed in situ with: 0.9 L of Vertimec® 18 EC/ha (RD); twice as much this dosage (2RD); and distilled water (Control), respectively, and to 2RD: control dilutions (12.5, 25, 50, 75%). All tests were performed under 25 ± 2°C, to simulate tropical conditions, and a 12hL:12hD photoperiod. The organisms avoided contaminated TAS for an EC(50,48h) = 3.918 mg/kg soil d.w., LOEC = 1.75 mg/kg soil d.w. and NOEC = 0.85 mg/kg soil d.w. No significant avoidance response occurred for any NS test. Abamectin concentrations in NS were rather lower than EC(50, 48h) and LOEC determined in TAS tests. The results obtained contribute to overcome a lack of ecotoxicological data on pesticides under tropical conditions, but more tests with different soil invertebrates are needed to improve pesticides risk analysis. PMID:22297724

  18. Supplementing five-point body condition score with body fat percentage increases the sensitivity for assessing overweight status of small to medium sized dogs

    OpenAIRE

    ARAI, Toshiro

    2012-01-01

    Gebin Li,1 Peter Lee,1 Nobuko Mori,1 Ichiro Yamamoto,1 Koh Kawasumi,1 Hisao Tanabe,2 Toshiro Arai11Department of Veterinary Science, School of Veterinary Medicine, Nippon Veterinary and Life Science University, 2Komazawa Animal Hospital, Tokyo, JapanBackground and methods: Currently, five-point body condition scoring (BCS) is widely used by veterinarians and clinicians to assess adiposity in dogs in Japan. However, BCS score assignment is subjective in nature, and most clinicians do not score...

  19. Predictors of Age of Diagnosis for Children with Autism Spectrum Disorder: The Role of a Consistent Source of Medical Care, Race, and Condition Severity.

    Science.gov (United States)

    Emerson, Natacha D; Morrell, Holly E R; Neece, Cameron

    2016-01-01

    Having a consistent source of medical care may facilitate diagnosis of autism spectrum disorders (ASD). This study examined predictors of age of ASD diagnosis using data from the 2011-2012 National Survey of Children's Health. Using multiple linear regression analysis, age of diagnosis was predicted by race, ASD severity, having a consistent source of care (CSC), and the interaction between these variables after controlling for birth cohort, birth order, poverty level, parental education, and health insurance. While African American children were diagnosed earlier than Caucasians, this effect was moderated by ASD severity and CSC. Having a CSC predicted earlier diagnosis for Caucasian but not African American children. Both physician and parent behaviors may contribute to diagnostic delays in minority children. PMID:26280401

  20. Bioconcentration of two pharmaceuticals (benzodiazepines) and two personal care products (UV filters) in marine mussels (Mytilus galloprovincialis) under controlled laboratory conditions

    OpenAIRE

    Gomez, E; Bachelot, M.; Boillot, C.; Munaron, D.; Chiron, Serge; Casellas, C; Fenet, H.

    2012-01-01

    Bioaccumulation is essential for gaining insight into the impact of exposure to organic micropollutants in aquatic fauna. Data are currently available on the bioaccumulation of persistent organic pollutants, but there is very little documentation on the bioaccumulation of pharmaceuticals and personal care products (PPCPs). The bioconcentration of selected PPCPs was studied in marine mussels (Mytilus galloprovincialis). The selected PPCPs were two organic UV filters, i.e., 2-ethylhexyl-4-trime...

  1. Persistent and non-persistent strains of Listeria monocytogenes: A focus on growth kinetics under different temperature, salt, and pH conditions and their sensitivity to sanitizers.

    Science.gov (United States)

    Magalhães, R; Ferreira, V; Brandão, T R S; Palencia, R Casquete; Almeida, G; Teixeira, P

    2016-08-01

    This study aimed to investigate the effect of different conditions, including temperature (37 °C, 22 °C, and 4 °C), NaCl concentrations (2.5%, 4%, and 8%), and acidity (pH = 5), on the growth response of persistent and non-persistent isolates of Listeria monocytogenes. The resistance to two common sanitizers (benzalkonium chloride and hydrogen peroxide) was also investigated. A selected group of 41 persistent and non-persistent L. monocytogenes isolates recovered from three cheese processing plants during a previous longitudinal study was assembled. Average lag time was similar for persistent and non-persistent isolates grown at 37 °C, 22 °C and 4 °C but significantly shorter (p < 0.05) for persistent isolates grown at 2.5%, 4% and 8% NaCl, and at pH 5. Average growth rates were significantly higher (p < 0.05) for persistent than for non-persistent isolates when grown at 22 °C, 2.5%, 4% and 8% NaCl, and at pH 5. These results suggest that persistent strains may be better adapted to grow under stressful conditions frequently encountered in food processing environments than non-persistent strains. No relation between persistence and resistance to the tested sanitizers was found. PMID:27052708

  2. Influence of Desorption Conditions on Analyte Sensitivity and Internal Energy in Discrete Tissue or Whole Body Imaging by IR-MALDESI

    Science.gov (United States)

    Rosen, Elias P.; Bokhart, Mark T.; Ghashghaei, H. Troy; Muddiman, David C.

    2015-06-01

    Analyte signal in a laser desorption/postionization scheme such as infrared matrix-assisted laser desorption electrospray ionization (IR-MALDESI) is strongly coupled to the degree of overlap between the desorbed plume of neutral material from a sample and an orthogonal electrospray. In this work, we systematically examine the effect of desorption conditions on IR-MALDESI response to pharmaceutical drugs and endogenous lipids in biological tissue using a design of experiments approach. Optimized desorption conditions have then been used to conduct an untargeted lipidomic analysis of whole body sagittal sections of neonate mouse. IR-MALDESI response to a wide range of lipid classes has been demonstrated, with enhanced lipid coverage received by varying the laser wavelength used for mass spectrometry imaging (MSI). Targeted MS2 imaging (MS2I) of an analyte, cocaine, deposited beneath whole body sections allowed determination of tissue-specific ion response factors, and CID fragments of cocaine were monitored to comment on wavelength-dependent internal energy deposition based on the "survival yield" method.

  3. Preparing the Pediatric Dentist for Palliative and End-of-life Care.

    Science.gov (United States)

    Sarvas, Elise W; Schwantes, Scott A; Karp, Jeffrey M

    2016-01-01

    Pediatric dentists are the primary providers of dental homes for children with life-threatening and complex chronic conditions. These children are increasingly living at home and seeking health care in community-based settings, including dental offices. Pediatric dentists may feel ill prepared to assume the roles and responsibilities of a pediatric palliative care provider due to limited education and training during dental school and residency; however, they should be sensitive to the palliative care needs of children and families. The purpose of this clinical article was to highlight palliative care scenarios in pediatric dentistry and provide actionable resources to empower pediatric dentists to gather health care information, make informed ethical decisions, promote patient- and family-centered care, and prepare dentists and their dental teams for episodes of death and bereavement when providing a dental home to patients with life-threatening and complex chronic conditions. PMID:27557917

  4. Development, validation and application of a sensitive analytical method for residue determination and dissipation of imidacloprid in sugarcane under tropical field condition.

    Science.gov (United States)

    Ramasubramanian, T; Paramasivam, M; Nirmala, R

    2016-06-01

    A simple and sensitive analytical method has been developed and validated for the determination of trace amounts of imidacloprid in/on sugarcane sett, stalk and leaf. The method optimized in the present study requires less volume of organic solvent and time. Hence, this method is suitable for high-throughput analyses involving large number of samples. The limit of detection (LOD) and limit of quantification (LOQ) of the method were 0.003 and 0.01 mg/kg, respectively. The recovery and relative standard deviation were more than 93 % and less than 4 %, respectively. Thus, it is obvious that the analytical method standardized in this study is more precise and accurate enough to determine the residues of imidacloprid in sugarcane sett, stalk and leaf. The dissipation and translocation of imidacloprid residues from treated cane setts to leaf and stalk were studied by adopting this method. In sugarcane setts, the residues of imidacloprid persisted up to 120 days with half-life of 15.4 days at its recommended dose (70 g a.i./ha). The residues of imidacloprid were found to be translocated from setts to stalk and leaf. The imidacloprid residues were detected up to 105 days in both leaf and stalk. Dipping of sugarcane setts in imidacloprid at its recommended dose may result in better protection of cane setts and established crop because of higher initial deposit (>100 mg/kg) and longer persistence (>120 days). PMID:27230427

  5. Sensitivity studies of high-resolution RegCM3 simulations of precipitation over the European Alps: the effect of lateral boundary conditions and domain size

    Science.gov (United States)

    Nadeem, Imran; Formayer, Herbert

    2015-08-01

    A suite of high-resolution (10 km) simulations were performed with the International Centre for Theoretical Physics (ICTP) Regional Climate Model (RegCM3) to study the effect of various lateral boundary conditions (LBCs), domain size, and intermediate domains on simulated precipitation over the Great Alpine Region. The boundary conditions used were ECMWF ERA-Interim Reanalysis with grid spacing 0.75∘, the ECMWF ERA-40 Reanalysis with grid spacing 1.125 and 2.5∘, and finally the 2.5∘ NCEP/DOE AMIP-II Reanalysis. The model was run in one-way nesting mode with direct nesting of the high-resolution RCM (horizontal grid spacing Δx = 10 km) with driving reanalysis, with one intermediate resolution nest (Δx = 30 km) between high-resolution RCM and reanalysis forcings, and also with two intermediate resolution nests (Δx = 90 km and Δx = 30 km) for simulations forced with LBC of resolution 2.5∘. Additionally, the impact of domain size was investigated. The results of multiple simulations were evaluated using different analysis techniques, e.g., Taylor diagram and a newly defined useful statistical parameter, called Skill-Score, for evaluation of daily precipitation simulated by the model. It has been found that domain size has the major impact on the results, while different resolution and versions of LBCs, e.g., 1.125∘ ERA40 and 0.7∘ ERA-Interim, do not produce significantly different results. It is also noticed that direct nesting with reasonable domain size, seems to be the most adequate method for reproducing precipitation over complex terrain, while introducing intermediate resolution nests seems to deteriorate the results.

  6. Multiple chemical sensitivity

    DEFF Research Database (Denmark)

    Tran, Marie Thi Dao; Arendt-Nielsen, Lars; Kupers, Ron;

    2013-01-01

    BACKGROUND: Multiple Chemical Sensitivity (MCS) is a chronic condition characterized by recurrent, non-specific symptoms in response to chemically unrelated exposures in non-toxic concentrations. Although the pathophysiology of MCS remains unknown, central sensitization may be an important factor...

  7. Estado de salud y utilización de recursos sanitarios de una población de ancianos atendidos en domicilio Health conditions and use of social care resources in a population of the elderly taken care at home

    Directory of Open Access Journals (Sweden)

    Carmen Gálvez-Romero

    2007-09-01

    Full Text Available La población de personas mayores, respecto a la población general en España, representa un 15,4%, proporción que aumentará en el futuro, sobre todo en mayores de 80 años. La atención domiciliaria de esta población es alternativa a su institucionalización, por lo que interesa conocer sus características sociodemográficas, clínicas y de utilización de recursos sanitarios para responder a sus necesidades reales. Se realizó un estudio de corte transversal en pacientes incluidos en un programa de incapacitados. Se estudiaron variables sociodemográficas y clínicas, capacidad funcional y cognitiva, y utilización de recursos sociosanitarios. Nuestros pacientes son una población mayor, presentan deterioro cognitivo importante, nivel elevado de dependencia y comorbilidad. Una quinta parte considera su estado de salud como malo. Utilizan con frecuencia los servicios de urgencia y, en menor medida, ingresan en el hospital. Algunas características sociodemográficas de estos pacientes determinan su nivel de audición y estado mental, tales como la edad, ocupación en su etapa laboral e ingresos económicos. Se mostraron determinantes de la utilización de los servicios sanitarios las patologías crónicas, la polifarmacia, escasamente las incapacidades funcionales y los ingresos económicos.Older persons represent 15,4% of the population of Spain. This proportion will increase in the future, especially for persons older than 80 years of age. As home care for this population is an alternative to their institutionalization, it is necessary to determine their sociodemographic and clinical characteristics, as well as their use of health care resources, in order to respond to their true needs. We undertook a cross-sectional study of patients included in an Incapacity Program. Variables studied included sociodemographic and clinical factors, functional and cognitive capacity, and the use of health and social care resources. The patients were

  8. Hygiene guideline for the planning, installation, and operation of ventilation and air-conditioning systems in health-care settings - Guideline of the German Society for Hospital Hygiene (DGKH).

    Science.gov (United States)

    Külpmann, Rüdiger; Christiansen, Bärbel; Kramer, Axel; Lüderitz, Peter; Pitten, Frank-Albert; Wille, Frank; Zastrow, Klaus-Dieter; Lemm, Friederike; Sommer, Regina; Halabi, Milo

    2016-01-01

    Since the publication of the first "Hospital Hygiene Guideline for the implementation and operation of air conditioning systems (HVAC systems) in hospitals" (http://www.krankenhaushygiene.de/informationen/fachinformationen/leitlinien/12) in 2002, it was necessary due to the increase in knowledge, new regulations, improved air-conditioning systems and advanced test methods to revise the guideline. Based on the description of the basic features of ventilation concepts, its hygienic test and the usage-based requirements for ventilation, the DGKH section "Ventilation and air conditioning technology" attempts to provide answers for the major air quality issues in the planning, design and the hygienically safe operation of HVAC systems in rooms of health care. PMID:26958457

  9. Building the eye care team

    OpenAIRE

    Thulasiraj Ravilla; Gnanasekaran Chinnathambi

    2014-01-01

    Eye care services are people intensive. They require the right people (competence), in the right numbers (capacity), in the right mix (team) with the right resources and processes (enabling conditions) to ensure effective and sustainable delivery of patient care.

  10. Sensitivity to initial conditions of a d-dimensional long-range-interacting quartic Fermi-Pasta-Ulam model: Universal scaling.

    Science.gov (United States)

    Bagchi, Debarshee; Tsallis, Constantino

    2016-06-01

    We introduce a generalized d-dimensional Fermi-Pasta-Ulam model in the presence of long-range interactions, and perform a first-principle study of its chaos for d=1,2,3 through large-scale numerical simulations. The nonlinear interaction is assumed to decay algebraically as d_{ij}^{-α} (α≥0), {d_{ij}} being the distances between N oscillator sites. Starting from random initial conditions we compute the maximal Lyapunov exponent λ_{max} as a function of N. Our N≫1 results strongly indicate that λ_{max} remains constant and positive for α/d>1 (implying strong chaos, mixing, and ergodicity), and that it vanishes like N^{-κ} for 0≤α/dunity, it monotonically decreases from unity to zero, remaining so for all α/d>1. The value α/d=1 can therefore be seen as a critical point separating the ergodic regime from the anomalous one, κ playing a role analogous to that of an order parameter. This scaling law is consistent with Boltzmann-Gibbs statistics for α/d>1, and possibly with q statistics for 0≤α/d<1. PMID:27415261

  11. Working conditions, health and productivity among dentists in Swedish public dental care - a prospective study during a 5-year period of rationalisation

    DEFF Research Database (Denmark)

    Rolander, B.; Jonker, D.; Winkel, Jørgen;

    2013-01-01

    In recent decades, comprehensive rationalisations have been implemented in public dentistry in Sweden. How rationalisations affect working conditions, health and production from a long-term perspective has been poorly investigated. This study aims to analyse changes and associations in dentists......' working conditions, health and productivity during a 5-year period. In 2003 and 2008, 65 dentists responded to questionnaires measuring work conditions and health. Treatment times for patients and productivity were tracked in electronic registers. Paired t-tests showed that the number of treated adult...... patients per dentist increased, and perceived physical working conditions improved while perceived work control and leadership deteriorated. Structural equation modelling showed that physical factors were important for health and productivity. When assessing risks in the work environment, there is a need...

  12. Sensitivity analysis

    Science.gov (United States)

    ... page: //medlineplus.gov/ency/article/003741.htm Sensitivity analysis To use the sharing features on this page, please enable JavaScript. Sensitivity analysis determines the effectiveness of antibiotics against microorganisms (germs) ...

  13. Gluten Sensitivity

    Science.gov (United States)

    ... like medicines, vitamins, and supplements. People with gluten sensitivity have problems with gluten. It is different from ... small intestine. Some of the symptoms of gluten sensitivity are similar to celiac disease. They include tiredness ...

  14. Child Care Centres.

    Science.gov (United States)

    Australian Dept. of Labour and National Service, Melbourne. Women's Bureau.

    Based on a survey of legislation relating to full-day care for preschool children of working mothers and a study of records, this report: (1) covers the number of registered child care centers in Australia and the number of children being served, (2) sets the conditions applying to registration of centers, (3) indicates the extent and levels of…

  15. Prenatal Care

    Science.gov (United States)

    ... am thinking about getting pregnant. How can I take care of myself? You should start taking care of ... What should I do — or not do — to take care of myself and my unborn baby? Follow these ...

  16. Self Care

    Science.gov (United States)

    ... Care Connections Experiences Research Learning Evaluation Print Email Self Care If you are living with a chronic ... help you cope can make a real difference. Self-care techniques are things you can do for ...

  17. Skin Care and Aging

    Science.gov (United States)

    ... page please turn Javascript on. Skin Care and Aging How Aging Affects Skin Your skin changes with age. It ... if they bother you. See additional resources on aging skin, including information on treatment options, specific conditions, ...

  18. Nontraumatic dental condition-related visits to emergency departments on weekdays, weekends and night hours: findings from the National Hospital Ambulatory Medical Care survey

    OpenAIRE

    Okunseri C; Okunseri E; Fischer MC; Sadeghi SN; Xiang Q; Szabo A

    2013-01-01

    Christopher Okunseri,1 Elaye Okunseri,1 Melissa Christine Fischer,1 Saba Noori Sadeghi,1 Qun Xiang,2 Aniko Szabo21Department of Clinical Services, School of Dentistry, Marquette University, Milwaukee, WI, USA; 2Division of Biostatistics, Institute of Health and Society, Medical College of Wisconsin, Milwaukee, WI, USAObjective: To determine whether the rates of nontraumatic dental condition (NTDC)-related emergency department (ED) visits are higher during the typical working hours of dental o...

  19. Abscisic Acid and Cytokinin-Induced Osmotic and Antioxidant Regulation in Two Drought-Tolerant and Drought-Sensitive Cultivars of Wheat During Grain Filling Under Water Deficit in Field Conditions

    Directory of Open Access Journals (Sweden)

    Mohammad-Reza SARAFRAZ-ARDAKANI

    2014-09-01

    Full Text Available Phytohormones play critical roles in regulating plant responses to stress. The present study investigates the effect of cytokinin, abscisic acid and cytokinin/abscisic acid interaction on some osmoprotectants and antioxidant parameters induced by drought stress in two wheat cultivars (Triticum aestivum L. of ‘Pishgam’ and ‘MV-17’ as tolerant and sensitive to drought during post-anthesis phase, respectively grown in field conditions. The most considerable effect of the treatments was exhibited 21 days after anthesis. Under drought conditions, the flag leaf soluble carbohydrate content increased in both cultivars while starch content was remarkably decreased in ‘Pishgam’ as compared to ‘MV-17’. Abscisic acid increased total soluble sugar and reduced starch more than other hormonal treatments, although it decreased studied monosaccharaides in ‘Pishgam’, especially. Drought stress induced high proportion of gylycinebetain and free proline in ‘Pishgam’ cultivar. Application of abscisic acid and cytokinin/abscisic acid interaction increased gylycinebetain and proline content in both cultivars under irrigation and drought conditions. The tolerant cultivar exhibited less accumulation of hydrogen peroxide and malondialdehyde in relation to significant increase of catalase and peroxidase activities and α-tocpherol content under drought conditions. All hormonal treatments increased the named enzyme activities under both irrigation and drought conditions, while higher accumulation of α-tocopherol was only showed in case of cytokinin application. Also, abscisic acid and cytokinin/abscisic acid could decrease drought-induced hydrogen peroxide and malondialdehyde level to some extent, although abscisic acid increased both of hydrogen peroxide andmalondialdehyde content in irrigation phase, especially.

  20. Sensitivity analysis

    International Nuclear Information System (INIS)

    General remarks on sensitivity analysis, the study of changes in a model output produced by varying model inputs, are made first. Sampling methods are discussed, and three sensitivity measures: partial rank correlation, derivative or response surface, and partial variance are described. Some sample results for a 16-input, 13-output hydrodynamics model are given. Both agreement and disagreement were found among the sensitivity measures. 4 figures

  1. Nursing Care of Women Who Have Undergone Genital Cutting.

    Science.gov (United States)

    Tilley, Donna Scott

    2015-01-01

    Female genital cutting (FGC), commonly called female genital mutilation, affects millions of women but is poorly understood by many health care providers. FGC procedures intentionally alter the female genital organs for nonmedical reasons and include partial or total removal of female genital organs. These procedures, which have no medical value, are usually done between birth and puberty. Health consequences vary in severity but can be devastating. Women who have experienced FGC may be reluctant to seek health care or to disclose their condition to providers. Suggestions for culturally competent care of women who have experienced FGC are outlined, focusing on understanding the cultural beliefs and values of women who have undergone these procedures and providing informed and sensitive care. PMID:26460917

  2. Radiation sensitizers

    International Nuclear Information System (INIS)

    The following classes of radiosensitizers are discussed: electron affinic compounds, pyrimidine analogs, and antibiotics. Metronidazole and nitroimidazole are discussed as examples of electron-affinic compounds. Studies on the enhancement ratio for sensitization of x-irradiated hamster cells showed that these drugs sensitize at concentrations much lower than the toxic concentrations. Criteria for a clinically useful hypoxic cell sensitizer are listed and mechanisms of electron-affinic sensitizers are discussed. The radiosensitizing effects of the pyrimidine analogs, BUDR, BCDR, IUDR, CUDR, and FUDR, are examined and the enhancement of radiation effects by the chemotherapeutic agent, 5-fluorouracil, is discussed. Other agents discussed are methotrexate, actinomycin D, bleomycin, and adriamycin

  3. Maternal perception regarding child care and development

    Directory of Open Access Journals (Sweden)

    Mirna Albuquerque Frota

    2011-09-01

    Full Text Available Objective: To investigate the perception of mothers regarding the care and development of their children. Methods: This was a descriptive and qualitative study, conducted in a Basic Health Unit (UBS in Fortaleza-CE, Brazil, in the period from July to October, 2008. The subjects were twenty mothers who accompanied their children in childcare consultation and met with favorable clinical conditions. Data collection techniques used free observation and semistructured interview consisting of questions involving the perception of child development and care. Results: By means of data analysis the following categories emerged: “Smile and play: mother’s perception regarding the development of the child”; “Take care: emphasis on breastfeeding and body hygiene”. The main source of nonverbal communication that the child has to convey affection and love is the smile, being an essential activity to child development. We verified that the care with breastfeeding and body hygiene suggest behavioral indicators of maternal sensitivity. Final considerations: The childcare consultation held in UBS is essential, because it allows integration of ideas and actions shared with the professional-parent dyad, thus providing the arousal of new experiences in care and the influence on child development.

  4. Bioconcentration of two pharmaceuticals (benzodiazepines) and two personal care products (UV filters) in marine mussels (Mytilus galloprovincialis) under controlled laboratory conditions.

    Science.gov (United States)

    Gomez, Elena; Bachelot, Morgane; Boillot, Clotilde; Munaron, Dominique; Chiron, Serge; Casellas, Claude; Fenet, Hélène

    2011-08-01

    Bioaccumulation is essential for gaining insight into the impact of exposure to organic micropollutants in aquatic fauna. Data are currently available on the bioaccumulation of persistent organic pollutants, but there is very little documentation on the bioaccumulation of pharmaceuticals and personal care products (PPCPs). The bioconcentration of selected PPCPs was studied in marine mussels (Mytilus galloprovincialis). The selected PPCPs were two organic UV filters, i.e., 2-ethylhexyl-4-trimethoxycinnamate (EHMC) and octocrylene (OC), and two benzodiazepines (BZP), i.e., diazepam (DZP) and tetrazepam (TZP). Laboratory experiments were performed in which M. galloprovincialis was exposed to these compounds either directly from water, for the less lipophilic substances (BZP) or via spiked food for lipophilic UV filters. M. galloprovincialis uptook and eliminated BZP following first-order kinetics. The biological half-life (t (1/2)) of TZP was 1.4 days, resulting in a bioconcentration factor of 64 and 99 mL g(-1) dry weight (dw), respectively, for 2.3 and 14.5 μg L(-1) of exposure, while the biological half-life (t (1/2)) of DZP was 0.4 days, resulting in a bioconcentration factor of 51 mL g(-1) dw for 13.2 μg L(-1) of exposure. The uptake of UV filter was rapid in mussels, followed by elimination within 24 h. EHMC increased from 15 to 138 ng g(-1) dw in 1 h and decreased to 25 ng g(-1) after 24 h for 11.9 μg L(-1) exposure. OC reached 839 ng g(-1) dw after 1 h and decreased to 33 ng g(-1) after 24 h for 11.6 μg L(-1) exposure. However, EHMC and OC were slightly accumulated in 48 h, i.e., 38 and 60 ng g(-1) dw, respectively. PMID:22828885

  5. Cues of maternal condition influence offspring selfishness.

    Directory of Open Access Journals (Sweden)

    Janine W Y Wong

    Full Text Available The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism and extracted and analyzed the females' cuticular hydrocarbons (CHC. Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons.

  6. Cues of maternal condition influence offspring selfishness.

    Science.gov (United States)

    Wong, Janine W Y; Lucas, Christophe; Kölliker, Mathias

    2014-01-01

    The evolution of parent-offspring communication was mostly studied from the perspective of parents responding to begging signals conveying information about offspring condition. Parents should respond to begging because of the differential fitness returns obtained from their investment in offspring that differ in condition. For analogous reasons, offspring should adjust their behavior to cues/signals of parental condition: parents that differ in condition pay differential costs of care and, hence, should provide different amounts of food. In this study, we experimentally tested in the European earwig (Forficula auricularia) if cues of maternal condition affect offspring behavior in terms of sibling cannibalism. We experimentally manipulated female condition by providing them with different amounts of food, kept nymph condition constant, allowed for nymph exposure to chemical maternal cues over extended time, quantified nymph survival (deaths being due to cannibalism) and extracted and analyzed the females' cuticular hydrocarbons (CHC). Nymph survival was significantly affected by chemical cues of maternal condition, and this effect depended on the timing of breeding. Cues of poor maternal condition enhanced nymph survival in early broods, but reduced nymph survival in late broods, and vice versa for cues of good condition. Furthermore, female condition affected the quantitative composition of their CHC profile which in turn predicted nymph survival patterns. Thus, earwig offspring are sensitive to chemical cues of maternal condition and nymphs from early and late broods show opposite reactions to the same chemical cues. Together with former evidence on maternal sensitivities to condition-dependent nymph chemical cues, our study shows context-dependent reciprocal information exchange about condition between earwig mothers and their offspring, potentially mediated by cuticular hydrocarbons. PMID:24498046

  7. Condition of mycoplasma infection of genitourinary tract and drug sensitive tests%泌尿生殖道支原体感染情况及药敏分析

    Institute of Scientific and Technical Information of China (English)

    刘宏; 李静; 王艳新; 张欣

    2011-01-01

    目的 了解本地区支原体在人类泌尿生殖系统的感染及药敏情况,指导临床合理用药.方法 采用支原体培养及药敏试剂盒对420例泌尿生殖道感染患者进行支原体培养和鉴定,并进行了12种常用抗生素的药敏试验.结果 420例泌尿生殖道感染患者中,支原体阳性205例,阳性率为48.8%,其中女性感染率(66.5%)高于男性感染率(30.2%)(P<0.05).解脲支原体(Uu)、人型支原体(Mh)、混合(Uu+Mh)感染率分别为29.8%、0.7%、18.3%;药敏结果显示支原体对美满霉素和强力霉素敏感性较高.结论 美满霉素和强力霉素可作为目前本地区治疗泌尿生殖道感染的首选药物.%Objective To understand the conditions of genitourinary system mycoplasma infection and drug sensitivity and provide rational administration for clinical practice. Methods The mycoplasma was cultured and identified by mycoplasma culture and identification kits in 420 cases with urinary genital tract mycoplasma infection and the sensitivity of mycoplasma to 12 antibacterials were tested. Results In 420 suspected cases,positive rate of mycoplasma was 48. 8% (205 cases) ,and the female infection rate(66. 5% ) was significantly higher than that of male(30.2% )(P<0.05). The Ureaplasma urealytic-um( Uu) ,Mycoplasma homins( Mh) and Uu + Mh infection rates were 29. 8% ,0. 7% , 18. 3% respectively. The sensitive tests showed that the mycoplasma had higher sensitivity to minocycline and deoxycycline. Conclusion The minocycline and deoxycycline can be used as the first choice drug for treatment genitourinary tract mycoplasma infection.

  8. Sensitive skin: An overview

    Directory of Open Access Journals (Sweden)

    Arun C Inamadar

    2013-01-01

    Full Text Available Sensitive skin is less tolerant to frequent and prolonged use of cosmetics and toiletries. It is self-diagnosed and typically unaccompanied by any obvious physical signs of irritation. With the change in lifestyle and also with increased opportunity to use many new brands of cosmetics and toiletries, there has been an increase in females complaining of unique sensation in their facial skin. Sensitive skin presents as smarting, burning, stinging, itching, and/or tight sensation in their facial skin. The condition is found in more than 50% of women and 40% of men, creating a sizable demand for products designed to minimize skin sensitivity. Good numbers of invasive and non-invasive tests are designed to evaluate and predict the sensitive skin. Management includes guidelines for selecting suitable cosmetics and toiletries in sensitive skin individuals.

  9. Work conditions and ergonomic factors of health risks to the nursing team of the Mobile Emergency Care - SAMU in Recife-PE city

    Directory of Open Access Journals (Sweden)

    Ednaldo Cavalcante de Araújo

    2010-01-01

    Full Text Available Objective: to analyze the work conditions and ergonomic as factors of risks to health of the nursing team from Mobile Service Emergency SAMU/Recife-PE. Methods: this is about a descriptive and exploratory study, from quantitative approach. Population was performed from the nurse team. For data collection was applied a questionnaire of 37 questions, from July to September 2009. Data analysis was supported by the Epi-Info, with the presentation of the results in tables. This study has been approved by the Committee of Ethics in Research of the Federal University of Pernambuco (protocol number 064/09. Results: 61.9% of the sample had mental fatigue and muscle 65.1%; 73% said they received no guidance on ergonomics; when asked what could be done for the prevention of occupational illnesses related to the performance of its activities, 35% said the stretch, 11% continuing education, 16% of the exercise, 14% of gym work and 24% did not know. Regarding the gym work, 82.5% heard and this total, 92.1% think that could help in the prevention of musculoskeletal pain and would like the gym work in the service. Conclusion: The activity of the professional nurse who works in the SAMU is stressful to the musculoskeletal system, especially in regions of the spine, back, shoulders and neck.

  10. Allergic sensitization

    DEFF Research Database (Denmark)

    van Ree, Ronald; Hummelshøj, Lone; Plantinga, Maud; Poulsen, Lars K.; Swindle, Emily

    2014-01-01

    Allergic sensitization is the outcome of a complex interplay between the allergen and the host in a given environmental context. The first barrier encountered by an allergen on its way to sensitization is the mucosal epithelial layer. Allergic inflammatory diseases are accompanied by increased...... play a dominant role, B cells switch to IgE-production, a process that is more effective at young age. IgE-producing plasma cells have been shown to be long-lived, hiding in the bone-marrow or inflammatory tissues where they cannot easily be targeted by therapeutic intervention. Allergic sensitization...

  11. The impact of an Intermediate Care Hospital on the chain of care for hospitalized elderly people

    OpenAIRE

    Dahl, Unni Alice

    2016-01-01

    Better care for elderly people with chronic conditions and comprehensive care needs has become a health policy priority in many countries. Elderly patients are particularly vulnerable to discontinuities in care, and are often those most in need of a health care system that is capable of appropriate collaboration and communication across care levels. Various arrangements have been introduced to improve coordination of health care services for these patients. Intermediate care is...

  12. Gluten Sensitivity

    Science.gov (United States)

    Gluten is a protein found in wheat, rye, and barley. It is found mainly in foods but ... products like medicines, vitamins, and supplements. People with gluten sensitivity have problems with gluten. It is different ...

  13. Daily Care

    Science.gov (United States)

    ... to Know Online Tools Enhancing Daily Life Daily Plan Activities Communication Food & Eating Music & Art Personal Care Incontinence Bathing ... Tweet Email | Print Create a Daily Routine Daily Plan Activities Communication Food/Eating Get Tips on Personal Care Bathing ...

  14. Hair Care

    Science.gov (United States)

    ... Body Looking and feeling your best Hair care Hair care Short, long, curly, straight, up, down. Hair options can seem endless! Not all of what makes your hair look good comes from the outside, though. Good ...

  15. Continuing Care

    Science.gov (United States)

    ... Care Obesity at Midlife May Speed Alzheimer’s Onset Hello from my mom Easing the Behavior Problems of ... Managers Continuing Care FOR MORE ARTICLES CLICK HERE Hello from my mom Common Estate Planning Errors Alzheimer’s ...

  16. Tracheostomy care

    Science.gov (United States)

    ... this page: //medlineplus.gov/ency/patientinstructions/000076.htm Tracheostomy care To use the sharing features on this ... through your nose and mouth. Caring for Your Tracheostomy Once the hole in your neck is not ...

  17. Radioecological sensitivity

    International Nuclear Information System (INIS)

    After the release of radionuclide into the environment it is important to be able to readily identify major routes of radiation exposure, the most highly exposed individuals or populations and the geographical areas of most concern. Radioecological sensitivity can be broadly defined as the extent to which an ecosystem contributes to an enhanced radiation exposure to Man and biota. Radioecological sensitivity analysis integrates current knowledge on pathways, spatially attributes the underlying processes determining transfer and thereby identifies the most radioecologically sensitive areas leading to high radiation exposure. This identifies where high exposure may occur and why. A framework for the estimation of radioecological sensitivity with respect to humans is proposed and the various indicators by which it can be considered have been identified. These are (1) aggregated transfer coefficients (Tag), (2) action (and critical) loads, (3) fluxes and (4) individual exposure of humans. The importance of spatial and temporal consideration of all these outputs is emphasized. Information on the extent of radionuclide transfer and exposure to humans at different spatial scales is needed to reflect the spatial differences which can occur. Single values for large areas, such as countries, can often mask large variation within the country. Similarly, the relative importance of different pathways can change with time and therefore assessments of radiological sensitivity are needed over different time periods after contamination. Radioecological sensitivity analysis can be used in radiation protection, nuclear safety and emergency preparedness when there is a need to identify areas that have the potential of being of particular concern from a risk perspective. Prior identification of radioecologically sensitive areas and exposed individuals improve the focus of emergency preparedness and planning, and contribute to environmental impact assessment for future facilities. The

  18. Agencia de autocuidado y factores básicos condicionantes en adultos mayores Autocuidado e fatores básicos condicionantes em adultos maiores Self-care agency and basic conditioning factors in the elderly

    Directory of Open Access Journals (Sweden)

    Alba Rosa Fernández

    2011-07-01

    participacao de 240 adultos maiores, feito em julho de 2009. A Escala ASA foi utilizada para valorar a capacidade de autocuidado e a ficha de dados sócio-demográficos e de saúde (DSDS. Os dados foram analisados no SPSS, versao 15.0. Resultados: A média total ASA dos adultos maiores foi de 46,8; mostrando um desvio padrao de 4,6. 99,6% da populacao apresentaram uma "baixa capacidade do autocuidado", numa faixa de 24 a 59 pontos. A média de idade foi de 71,6 anos; o desvio padrao foi de 6,7; 48,8% da populacao pertenciam á faixa etária de 60-70 anos; 76,7% eram mulheres, 49,2% nao tinham educacao escolar; 42,5% eram viúvos, 70,4% trabalhavam como empregados domésticos; 53,3% pertenciam ao estrato social 1; 73,8% moravam com as suas famílias. 21,7% estavam afiliados ao Caprecom. 23,8% apresentaram problemas renais; 71,3% reportaram deficiencias visuais; 78,3% apresentavam uma média de tensao arterial normal e 84,2% apresentavam um pulso normal. 72% das femeas da populacao apresentam um diámetro abdominal que as poe em risco (mais de 80 cm. Conclusáo: Os adultos maiores apresentaram umabaixa capacidade de autocuidado e dos fatores básicos condicionantes que precisam da atencao da enfermaria.Self-care agency is the capacity of an individual to take care of him/ herself; elements of the individual or the environment he/she lives in may have influence, these are called basic conditioning factors. Purpose: To determine the self-care agency and basic conditioning factors in old patients with hypertension in Tunja, Boyacá, Colombia. Methods: Descriptive cross section study with 240 senior patients carried out in July 2009. ASA scale was used to assess self-care agency and the social-demographic and health data card (DSDS. Data were analyzed in SPSS, version 15.0. Results: The total ASA mean of seniors was 46,8, standard deviation of 4,6; 99,6% showed "low self-care agency", within a range of 24 to 59 points. Average age was 71,6, standard deviation of 6,7; 48,8% were

  19. Sensitization of Parker fittings

    International Nuclear Information System (INIS)

    At your request, ferrules from 316 SS Parker-Hannifen compression fittings at the FFTF have been examined and evaluated to determine the metallurgical condition as related to carbide precipitation in grain boundaries (known as sensitization) and the implications this may have with regard to corrosion resistance. To accomplish this, two ferrules from new stock, two ferrules from old stock and two ferrules that had seen service were examined metallurgically. The samples were prepared for optical metallography. They were viewed in both the etched and unetched condition and analyzed on the scanning electron microscope (SEM) for elemental content. It was confirmed that the ferrules from new stock had a 5 mil thick nitrided layer on the ferrule ID at the lead end and that the 316 SS ferrule material was in the sensitized condition, indicating low resistance to aqueous corrosion. The material from old stock had no nitride layer but was in the sensitized condition indicating low resistance to aqueous corrosion. The ferrules that had seen service had not been nitrided and were not sensitized indicating high resistance to aqueous corrosion

  20. The glucagon-like peptide 1 analogue Exendin-4 attenuates the nicotine-induced locomotor stimulation, accumbal dopamine release, conditioned place preference as well as the expression of locomotor sensitization in mice.

    Directory of Open Access Journals (Sweden)

    Emil Egecioglu

    Full Text Available The gastrointestinal peptide glucagon-like peptide 1 (GLP-1 is known to regulate consummatory behavior and is released in response to nutrient ingestion. Analogues of this peptide recently emerged as novel pharmacotherapies for treatment of type II diabetes since they reduce gastric emptying, glucagon secretion as well as enhance glucose-dependent insulin secretion. The findings that GLP-1 targets reward related areas including mesolimbic dopamine areas indicate that the physiological role of GLP-1 extends beyond food intake and glucose homeostasis control to include reward regulation. The present series of experiments was therefore designed to investigate the effects of the GLP-1 receptor agonist, Exendin-4 (Ex4, on established nicotine-induced effects on the mesolimbic dopamine system in mice. Specifically, we show that treatment with Ex4, at a dose with no effect per se, attenuate nicotine-induced locomotor stimulation, accumbal dopamine release as well as the expression of conditioned place preference in mice. In accordance, Ex4 also blocks nicotine-induced expression of locomotor sensitization in mice. Given that development of nicotine addiction largely depends on the effects of nicotine on the mesolimbic dopamine system these findings indicate that the GLP-1 receptor may be a potential target for the development of novel treatment strategies for nicotine cessations in humans.

  1. Caring for Kids With Medical Conditions

    Science.gov (United States)

    ... others have learning problems and delays in their development. Ask parents: If your child uses a wheelchair, leg braces, or walker, does ... to suggest activities for your time with their child. You can start with simple puzzles or coloring and plan other things to do ...

  2. Surveillance and recipients care in stable condition

    Institute of Scientific and Technical Information of China (English)

    John J. Curtis

    2011-01-01

    @@ For decades now, transplant physicians, during follow-up of successfully transplanted renal failure patients, have ordered frequent checks of the serum creatinine and urinalysis.1 These remain commonplace tools. Blood pressure measurement is preformed on every clinic visit along with a check of body weight and a check for edema.

  3. Dementia Care: Intersecting Informal Family Care and Formal Care Systems

    OpenAIRE

    Prabhjot Singh; Rafat Hussain; Adeel Khan; Lyn Irwin; Roslyn Foskey

    2014-01-01

    Dementia is one of the major causes of disability and dependence amongst older people and previous research has highlighted how the well-being of people with dementia is inherently connected to the quality of their relationships with their informal carers. In turn, these carers can experience significant levels of emotional stress and physical burden from the demands of caring for a family member with dementia, yet their uptake of formal services tends to be lower than in other conditions rel...

  4. Condicionantes en la utilización de los servicios de atención primaria: Evidencias empíricas e inconsistencias metodológicas Factors conditioning primary care services utilization: Empirical evidence and methodological inconsistencies

    Directory of Open Access Journals (Sweden)

    M. Sáez

    2003-10-01

    : problemas de diseño, errores de medida, errores de especificación y métodos estadísticos inadecuados. Como vías de solución citaríamos el diseño de cuasi experimentos, la utilización de grandes bases de datos administrativos, así como de fuentes de datos primarios (diseño; la distinción entre distintos tipos de utilización y entre unidades de análisis alternativas a la visita, y la corrección de errores de medida en las variables explicativas (errores de medida; la consideración de variables explicativas relevantes (errores de especificación, y la utilización de modelos multinivel (métodos estadísticos inadecuados.Introduction: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. Factors conditioning use: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. Methodological inconsistencies: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain

  5. Adaptability of Photo-Thermo Sensitive Genic Male Sterile Rice Line to Climate Condition in China%我国主要水稻光温敏核不育系类型的气候适应性

    Institute of Scientific and Technical Information of China (English)

    卢兴桂; 袁潜华; 姚克敏; 刘梅

    2001-01-01

    针对夏季低温对我国两系杂交稻制种生产的严重威胁,用1997~1998年由三亚、武昌、贵阳、南京4个生态点组成的“新不育系联合生态鉴定”试验资料,分析了以培矮64S为代表的实用低温敏类型不育系和以N5088S为代表的实用光敏类型不育系的育性光温影响规律。结果表明,培矮64S的育性受温度影响,育性稳定性较差,下限温度指标年际间和地区间变化较大;N5088S育性主要受日长影响,其临界光长同一地年际间差异小,但地区间差异较大。同时,用1951~1992年逐日平均气温和理论日长资料,分析和评价了我国南方稻区(18°14′~34°17′N)的三亚、南京、广州、福州、长沙、杭州、南京、高邮、徐州等9个城市的光温特征及其时空规律。在此基础上,从生态角度提出了克服夏季低温危害两系杂交稻制种的三项生态技术措施,一是要根据气候规律正确选择适宜的制种地区和季节;二是华中双季稻区应改秋制为春制或选择山区单季稻区秋制;三是应全面评价温敏和光敏类型不育系的特点,因气候合理地利用现有的水稻不育系资源。%Based on the data from the experiment “joint ecologicaldetermination of new sterile lines” at Sanya, Wuchang, Nanjing, and Guiyang in 1997-1998, fertility variation of Pei′ai64S(a low temperature sensitive sterile line) and N5088S(a photoperiod sensitive sterile line)under different daylength and temperature condition was analyzed. The results showed that the fertility of Pei′ai64S was dominantly affected by temperature and unstable,the critical low temperature for fertility conversion were different among years and cities; and that of N5088S was dominantly affected by daylength, difference of critical daylength for fertility conversion was small in different years in a city,but large in different cities. According to daily mean

  6. Work and health conditions of nursing staff in palliative care and hospices in Germany [Arbeitsbedingungen und Gesundheit von Pflegekräften auf Palliativstationen und stationären Hospizen in Deutschland

    Directory of Open Access Journals (Sweden)

    Schröder, Christina

    2004-11-01

    Full Text Available [english] Aims of this representative study were to assess the relevant differences between the work and organisational characteristics as well as the subjective resources and health status of nurses occupied in hospice care, compared to nurses from palliative stations. Further, the assessment of the predictive correlations between the work situation of this nurses as a factor influencing their health and perceived strains was also a leading intention. Method: In a written survey conducted in Germany in 2001, 820 nursing staff of 113 palliative stations and stationary hospices were included. A qualified diagnostic procedure for the assessment of health promoting work was implemented. In order of obtaining a secure comparison, a sample of 320 nurses working in 12 homes for old people in Saxony was also considered. Results: The nurses referred generally to favourable working conditions, still they informed about deficiencies in the perceived participation, organizational benefits and experienced gratification. Hospice nurses experienced overall more favourable work conditions than palliative nurses or than the staff of homes for old people (regarding identification with the institution, organizational benefits, accurate gratification and little time pressure during work. Hospice personnel were psychologically and physically healthier than the staff of palliative stations. Important predictors for health stability that could be assessed by multiple regression analysis were: positively evaluated work contents, the identification with the institution, little time pressure and a positive working atmosphere. Conclusions: The assessed organisational framework is generally more favourable in the institutions of professional terminal care than in common hospitals and homes for old people. Therefore, the conditions in hospices could have a modelling function for the inner-institutional work organisation and for the anchorage of the intrinsic motivation of

  7. Situación y perspectivas laborales de los técnicos de salud de atención primaria de Cataluña Working conditions of public health workers in the primary care in Catalonia, Spain

    Directory of Open Access Journals (Sweden)

    Maria Salut Martínez Ferrer

    2007-06-01

    Full Text Available Objetivos: Explorar la situación laboral de los técnicos de salud adscritos a las unidades docentes de medicina de familia y comunitaria de Cataluña. Métodos: Estudio transversal. Resultados: De 53 posibles técnicos de salud, se obtuvieron 40 respuestas, 29 completas. Más de la mitad de los técnicos de salud del Institut Català de la Salut son interinos. Sus principales actividades son la docencia, el apoyo metodológico a la investigación y la evaluación de servicios y personal sanitario. Desean mayor definición de sus funciones y mejorar sus condiciones de trabajo. Aunque una pequeña proporción considera muy difícil la coordinación en la salud pública, la mayoría muestra disposición a colaborar. Conclusiones: La inestabilidad laboral, las mejoras salariales y la definición de funciones son prioritarias para los técnicos de salud. Consideran deseable la coordinación de la atención primaria con los servicios de salud pública.Objective: To describe the working conditions and tasks of health workers in the health training unit of family medicine in Catalonia, Spain. Methods: Cross-sectional study. Results: Fifty-three public health workers were located. Forty responses were obtained, of which 29 were complete. More than half the health technicians in the Catalan Health Service had temporary contracts. Their main tasks were teaching, providing methodological assistance in research, and auditing healthcare services and healthcare workers. Health technicians wanted more precise job definition and better working conditions. Although a small proportion believed coordination of primary care and public health to be very difficult, most would take part in it. Conclusions: The main issues for public health workers were work instability, better salaries, and greater job definition. Coordination between primary care and public health was considered desirable.

  8. A Primer of Covert Sensitization

    Science.gov (United States)

    Kearney, Albert J.

    2006-01-01

    Covert sensitization is the first of a family of behavior therapy procedures called covert conditioning initially developed by Joseph Cautela in the 1960s and 1970s. The covert conditioning procedures involve the use of visualized imagery and are designed to work according to operant conditioning principles. When working with cooperative clients…

  9. Sensitive innovation

    DEFF Research Database (Denmark)

    Søndergaard, Katia Dupret

    Present paper discusses sources of innovation as heterogenic and at times intangible processes. Arguing for heterogeneity and intangibility as sources of innovation originates from a theoretical reading in STS and ANT studies (e.g. Callon 1986, Latour 1996, Mol 2002, Pols 2005) and from field work...... in the area of mental health (Dupret Søndergaard 2009, 2010). The concept of sensitive innovation is developed to capture and conceptualise exactly those heterogenic and intangible processes. Sensitive innovation is therefore primarily a way to understand innovative sources that can be......, but are not necessarily, recognized and acknowledged as such in the outer organisational culture or by management. The added value that qualifies these processes to be defined as “innovative” are thus argued for along different lines than in more traditional innovation studies (e.g. studies that build on the classic...

  10. Improved Sensitivity Relations in State Constrained Optimal Control

    International Nuclear Information System (INIS)

    Sensitivity relations in optimal control provide an interpretation of the costate trajectory and the Hamiltonian, evaluated along an optimal trajectory, in terms of gradients of the value function. While sensitivity relations are a straightforward consequence of standard transversality conditions for state constraint free optimal control problems formulated in terms of control-dependent differential equations with smooth data, their verification for problems with either pathwise state constraints, nonsmooth data, or for problems where the dynamic constraint takes the form of a differential inclusion, requires careful analysis. In this paper we establish validity of both ‘full’ and ‘partial’ sensitivity relations for an adjoint state of the maximum principle, for optimal control problems with pathwise state constraints, where the underlying control system is described by a differential inclusion. The partial sensitivity relation interprets the costate in terms of partial Clarke subgradients of the value function with respect to the state variable, while the full sensitivity relation interprets the couple, comprising the costate and Hamiltonian, as the Clarke subgradient of the value function with respect to both time and state variables. These relations are distinct because, for nonsmooth data, the partial Clarke subdifferential does not coincide with the projection of the (full) Clarke subdifferential on the relevant coordinate space. We show for the first time (even for problems without state constraints) that a costate trajectory can be chosen to satisfy the partial and full sensitivity relations simultaneously. The partial sensitivity relation in this paper is new for state constraint problems, while the full sensitivity relation improves on earlier results in the literature (for optimal control problems formulated in terms of Lipschitz continuous multifunctions), because a less restrictive inward pointing hypothesis is invoked in the proof, and because

  11. Point-of-care testing of HbA1c in diabetes care and preventable hospital admissions

    DEFF Research Database (Denmark)

    Kristensen, Troels; Rose Olsen, Kim

    Background: Point-of-care testing (POCT) of HbA1c may result in improved diabetic control, better patient outcomes and enhanced clinical efficiency with fewer patient visits and subsequent reductions in hospitalizations and costs. In 2008, the Danish regulators agreed to create a new tariff...... for the remuneration of POCT of HbA1c in primary care. Aim: The aim of this study is to assess whether there is an association between the use of POCT of HbA1c and preventable hospital admissions among diabetes patients in general practice. Method: We apply logistic regression analyses to examine whether...... there is a link between preventable hospital admissions and POCT of HbA1c in general practice. Preventable hospital admissions were assessed through the ambulatory care sensitive conditions (ACSCs) classification of hospital admissions. We include independent variables such as gender, age, ethnicity...

  12. Condicionantes estruturais da regionalização na saúde: tipologia dos Colegiados de Gestão Regional Structural conditions for regionalization in health care: typology of Regional Management Boards

    Directory of Open Access Journals (Sweden)

    Ana Luiza d'Ávila Viana

    2010-08-01

    Full Text Available O atraso na implementação da estratégia da regionalização e a fragilidade de iniciativas combinadas de descentralização e regionalização no Brasil requerem explicação. O artigo levanta algumas hipóteses para elucidar essa intricada questão e analisa os condicionantes estruturais do processo de regionalização em curso nos estados. Para isso, elabora uma tipologia nacional das regiões de saúde que as diferenciam segundo graus de desenvolvimento econômico, social e características da rede de saúde, dos municípios que compõem os Colegiados de Gestão Regional (CGR formalmente implantados até janeiro de 2010. Para a construção da tipologia, adotaram-se os modelos de análise fatorial e de análise de agrupamentos (cluster analysis. Foram identificados cinco grandes grupos socioeconômicos de CGR, descritos de acordo com sua distribuição regional, população, despesa em saúde, perfil da oferta (incluindo mix público e privado e cobertura de serviços de saúde. Os resultados encontrados servem como norteadores da constituição de redes de atenção à saúde e de novas iniciativas no campo regional, de forma a aprimorar a política de regionalização e favorecer a construção de instrumentos de regulação diversificados, flexíveis e, sobretudo, mais ajustados às realidades regionais.An explanation is required for the delay in implementing the regionalization strategy and the fragile nature of the combined decentralization and regionalization initiatives in Brazil. The article raises some hypotheses to clarify this intricate issue and reviews the structural conditioning factors of the regionalization process ongoing in the states. A national typology of the health care regions is prepared, differentiating them according to the degree of socio-economic development and the characteristics of the health care network and of the municipalities that form the Regional Management Boards (CGR, formally implanted by January

  13. Concept caring in nursing

    Directory of Open Access Journals (Sweden)

    Lenka Drahošová

    2016-05-01

    Full Text Available Aim: The aim of this literature review was to search for qualitative studies focusing on the concept of caring in nursing, to analyse them and to synthesize knowledge that concerns the definition of the concept of caring in nursing from the point of view of nurses and patients. Design: Review. Methods: Qualitative studies were searched for systematically in the electronic databases Academic Search Complete (EBSCO, CINAHL, Medline, Science Direct, and the Wiley Library Online, according to set criteria and defined key words for the period 1970-2015. Seven selected articles were analysed after selection of documents with the aid of a sorting chart. Results: Nurses understand caring in nursing as a relationship with patients which is characterised on the nurses' part by an individual and empathetic approach, attentiveness, experience and sensitivity. Through caring, active communication takes place, providing information which reduces anxiety and leads to the breaking down of barriers. This relationship helps protect patients' autonomy, dignity and comfort. It requires experience on the part of nurses, and it is influenced by the environment. The nurses' personal qualities (what professional knowledge, attitudes and skills they have and their availability, reliability, and emotional and physical support are important to patients. Conclusion: The concept of caring is a content specific interpersonal process which is characterized by the professional knowledge, skills, personal maturity, and interpersonal sensitivity of nurses, which result in the protection, emotional support, and the meeting of bio-psycho-social needs of patients. The results of the overview study could contribute to an explanation and understanding of the nature of caring as a fundamental feature of the discipline of nursing.

  14. 产后抑郁症产妇家庭关怀度与健康状况的相关性研究%Correlation research on family care degree and health condition of postpartum depression

    Institute of Scientific and Technical Information of China (English)

    李秀梅; 陈登宏; 张磊

    2014-01-01

    Objective To explore the correlation between family care degree and health condition of the puerperas with postpartum depression .Methods Totals of 98 puerperas with postpartum depression were evaluated by family APGAR index and self-rated health measurement scale ( SRILMS) , they were compared with 98 normal postpartum puerperas in same phase ,then analyze the correlation between them .Results The scores of APGAR[(6.75 ±2.27) vs (8.26 ±2.14)],and SRHMS[(274.73 ±55.61) vs (313.84 ±51.58)]of the puerperas with postpartum depression were significantly lower than that of the normal postpartum puerperas ( t=4.79, 5.11,respectively;P<0.01).Correlation analysis showed that positive correlation was found between APGAR and SRHMS(P<0.01).Conclusions The health condition and family care degree of the puerperas with postpartum depression is worse .While improving family care degree is conducive to prevent postpartum depression happening , and promote physical and mental rehabilitation of them .%目的:探讨产后抑郁症家庭关怀度与健康状况的相关性。方法采用家庭关怀度指数量表( APGAR)和自测健康评定量表( SRHMS)对98例产后抑郁症产妇进行测评,并与相匹配的98例正常产后产妇进行比较,分析其相关性。结果产后抑郁症产妇APGAR和SRHMS总分分别为(6.75±2.27),(274.73±55.61)分,明显低于正常产后产妇的(8.26±2.14),(313.84±51.58)分,差异有统计学意义( t分别为4.79,5.11;P<0.01);相关分析显示,APGAR评分各维度与SRHMS各维度均呈正相关(P<0.01)。结论产后抑郁症产妇健康状况与家庭关怀度较差,提高家庭关怀度有助于预防产后抑郁症的发生,促进身心康复。

  15. Generalist palliative care in hospital

    DEFF Research Database (Denmark)

    Bergenholtz, Heidi; Jarlbæk, Lene; Hølge-Hazelton, Bibi

    2016-01-01

    Background: It can be challenging to provide generalist palliative care in hospitals, owing to difficulties in integrating disease-orientedtreatment with palliative care and the influences of cultural and organisational conditions. However, knowledge on the interactionsthat occur is sparse. Aim: To...... investigate the interactions between organisation and culture as conditions for integrated palliative care in hospital and, ifpossible, to suggest workable solutions for the provision of generalist palliative care. Design: A convergent parallel mixed-methods design was chosen using two independent studies: a...... hospital with 29 department managements and one hospital management. Results: Two overall themes emerged: (1) ‘generalist palliative care as a priority at the hospital’, suggesting contrasting issues regardingprioritisation of palliative care at different organisational levels, and (2) ‘knowledge and use...

  16. Supportive Care.

    Science.gov (United States)

    Olsen, Pia Riis; Lorenzo, Rosalía

    2016-01-01

    This chapter takes its point of departure in psychosocial aspects of supportive care in adolescent and young adult cancer care. The purpose is to describe some of the challenges that these young people face following a cancer diagnosis and guide healthcare professionals in how to provide care that improves the quality of life. In most hospitals and healthcare systems, adolescents and young adults are cared for and treated in settings for children or adults. Accordingly, healthcare professionals may lack attention to and knowledge about what characterize young peoples' life situation, their special needs and how to meet them. The topics we include in the chapter are the following: the youth friendly environment, social support and social network, parents, information during a psychosocial crisis event, the use of HEADSS, peer support, fertility, body image and self-esteem, after treatment and future challenges and palliative and end of life care. PMID:27595353

  17. Collaborative Health Care Plan Support

    OpenAIRE

    Amir, Ofra; Grosz, Barbara J.; Law, Edith Lok Man; Stern, Roni

    2013-01-01

    This paper envisions a multi-agent system that assists patients and their health care providers. This system would support a diverse, evolving team in formulating, monitoring and revising a shared "care plan" that operates on multiple time scales in uncertain environments. It would also enhance communication of health information within this planning framework. The coordination of care for children with complex conditions (CCC), which is a compelling societal need, is presented as a model env...

  18. The chronic disease management in community health service institutions based on Innovative Care for the Chronic Conditions Framework%基于ICCC框架的社区卫生服务机构慢性病管理研究

    Institute of Scientific and Technical Information of China (English)

    袁莎莎; 王芳; 李陈晨; 刘利群; 周巍; 衡驰; 杨婷

    2015-01-01

    Objective:To study the chronic disease management’s key factors in community health service insti-tution based on the Innovative Care for Chronic Conditions Framework ( ICCC ) . Methods: The purposive sampling method was adopted. Twelve community health service centers were selected as the field survey sites in Beijing, Shanghai, Zhengzhou and Chengdu. During the key factors description at macro-, meso-and micro-level in the IC-CC framework, thematic framework analysis was used to describe the key factors at maro-, meso-and micro level in the ICCC framework. Results:From the community health institutions’ perspective, the key factors at meso level in the ICCC framework played a better role in the management of chronic conditions while the key factors in both macro and micro level still lacked. Conclusion:Based on the ICCC framework, the management of chronic diseases needs to emphasize the cooperation with relevant departments outside the health area and legislative strategies at macro level, the ability of community supporters to mobilize and coordinate resources at meso level and the improvement of self-management skills for the patients with chronic diseases.%目的::以世界卫生组织提出的慢性病创新照护框架( Innovative Care for Chronic Conditions Frame-work, ICCC)为理论基础,从社区卫生服务机构角度出发,分析慢性病管理相关要素的实现现状。方法:采取目的抽样,选取北京市、上海市、郑州市、成都市共12家社区卫生服务中心进行现场调查。采用主题框架法,围绕ICCC框架提出的宏观—中观—微观三层面的关键要素展开分析。结果:基于ICCC框架,从社区卫生服务机构角度来看,以卫生保健组织为代表的中观层面要素功能发挥较好,宏观和微观层面要素缺乏。结论:基于ICCC框架,慢性病管理需在宏观层面加强与卫生系统外相关部门的协作及相关立法;中观层面需加强社区资源或社区

  19. The role of sensitization in musculoskeletal shoulder pain

    OpenAIRE

    John Borstad; Christopher Woeste

    2015-01-01

    Introduction: Peripheral and central sensitization are neurophysiological processes that can prolong painful conditions. Painful shoulder conditions are often persistent, perhaps due to the presence of sensitization. Method: This manuscript summarizes six studies that have evaluated those with musculoskeletal shoulder pain for the presence of sensitization. Results: All six manuscripts report evidence of peripheral sensitization, while central sensitization was described in five of the studie...

  20. Building the eye care team

    Directory of Open Access Journals (Sweden)

    Thulasiraj Ravilla

    2014-07-01

    Full Text Available Eye care services are people intensive. They require the right people (competence, in the right numbers (capacity, in the right mix (team with the right resources and processes (enabling conditions to ensure effective and sustainable delivery of patient care.

  1. Effect of sample pooling and transport conditions on the clinical sensitivity of a real-time polymerase chain reaction assay for Campylobacter fetus subsp. venerealis in preputial samples from bulls.

    Science.gov (United States)

    García-Guerra, Alvaro; Waldner, Cheryl L; Pellegrino, Andrea; Macdonald, Nicole; Chaban, Bonnie; Hill, Janet E; Hendrick, Steven H

    2016-01-01

    The diagnosis of bovine genital campylobacteriosis (BGC) presents significant challenges, as traditional methods lack sensitivity when prolonged transport of samples is required. Assays of preputial samples by means of real-time polymerase chain reaction (PCR) provide good sensitivity and high throughput capabilities. However, there is limited information on the acceptable duration of transport and temperature during transport of samples. In addition, the use of pooled samples has proven to be a valuable strategy for the diagnosis of other venereal diseases in cattle. The objectives of the present study were to determine the effect of sample pooling and of transport time and temperature on the clinical sensitivity of a real-time quantitative PCR (qPCR) assay for Campylobacter fetus subsp. venerealis in preputial samples from beef bulls. Eight infected bulls and 176 virgin yearling bulls were used as the source of samples. The qPCR sensitivity was comparable for unpooled samples and pools of 5 samples, whereas sensitivity was decreased for pools of 10 samples. Sensitivity for the various pool sizes improved with repeated sampling. For shorter-term transport (2 and 48 h), sensitivity was greatest when the samples were stored at 4°C and 30°C, whereas for longer-term transport (96 h) sensitivity was greatest when the samples were stored at -20°C. The creation of pools of 5 samples is therefore a good option to decrease costs when screening bulls for BGC with the qPCR assay of direct preputial samples. Ideally the samples should be stored at 4°C and arrive at the laboratory within 48 h of collection, but when that is not possible freezing at -20°C could minimize the loss of sensitivity. PMID:26733730

  2. Palliative care in home care: perceptions of occupational therapists

    Directory of Open Access Journals (Sweden)

    Séfora Gomez Portela

    2015-03-01

    Full Text Available This research aimed at understanding and reflecting on the perceptions of occupational therapists regarding the implementation of palliative care in home care. This is an exploratory, qualitative study, through semi-structured interviews, conducted in the second semester of 2012 with eight occupational therapists with experience in palliative care in the city of São Paulo. Content analysis identified four themes: characterization and professional trajectory in the field, understanding the concepts of palliative care, home care and palliative care, and occupational therapy and palliative care in home care. The results suggest that the role of the occupational therapist in this field has taken place at different levels of health care, being addressed to people with varying needs. The use of the concept of palliative care by the interviewees exceeds the notion of end of life, following the changes in the epidemiological transition. They understand that professional services follow the trend of national palliative care services with focus on specialized levels, but manifest the importance of its implementation in primary and home care. Among the barriers to practice, they identified the complexity of “being at home “, peculiarities of palliative care with high cost demands, lack of infrastructure and implementation of the current policy. Professional training and scientific roduction in the area were viewed as inadequate, although they identified a call for change. The interviewees recognized palliative care in home care as a strong professional field, but one still requiring study and discussions regarding its limits and conditions of implementation, especially in the Unified Health System.

  3. Careful science?

    DEFF Research Database (Denmark)

    Jespersen, Astrid P; Bønnelycke, Julie; Eriksen, Hanne Hellerup

    2014-01-01

    into different exercise groups. In this article we analyse the scientific work of the trial as representing entangled processes of bodywork, where data are extracted and objectified bodies are manipulated and care practices address the emotional, social and mundane aspects of the participants' everyday...... lives. Care practices are an inherent part of producing scientific facts but they are removed from the recognised results of scientific practice and thus from common public health recommendations. However, knowledge about the strategic use of care practices in lifestyle interventions is important for...

  4. Self-Care Technologies in HCI

    DEFF Research Database (Denmark)

    Nunes, Francisco; Verdezoto, Nervo; Fitzpatrick, Geraldine;

    2015-01-01

    Many studies show that self-care technologies can support patients with chronic conditions and their carers in understanding the ill body and increasing control of their condition. However, many of these studies have largely privileged a medical perspective and thus overlooked how patients and...... increasing the influence on medical research and practice around self-care technology....... carers integrate self-care into their daily lives and mediate their conditions through technology. In this review, we focus on how patients and carers use and experience self-care technology through a Human-Computer Interaction (HCI) lens. We analyse studies of self-care published in key HCI journals and...

  5. Primary care and ophthalmology in the United Kingdom

    OpenAIRE

    Riad, S F; Dart, J K G; Cooling, R J

    2003-01-01

    The National Health Service is now primary care led. There are different definitions for primary care and in this review they are analysed and related to ophthalmology to produce a working definition for ophthalmic primary care, summarised as the provision of first contact care for all ophthalmic conditions and follow up, preventive, and rehabilitative care of selected ophthalmic conditions, in a variety of settings, by a diverse workforce. The attributes of primary care are first contact, ac...

  6. Providing Palliative Care to LGBTQ Patients.

    Science.gov (United States)

    Barrett, Nina; Wholihan, Dorothy

    2016-09-01

    Nurses should be familiar with and equipped to address the challenges that arise when caring for lesbian, gay, bisexual, transgender, or queer-identified (LGBTQ) patients. LGBTQ individuals have increased rates of certain physical diseases and are at greater risk of suffering from stress-sensitive mental health issues. Negative social attitudes, widespread discrimination and stigma, physical and psychological victimization, and less social support with aging contribute to the complexity of care for these individuals. Open communication, welcoming and accepting attitudes and environments, and sensitivity to unique multidimensional issues improve care to LGBTQ patients with serious advanced illness. Nursing can reach this vulnerable minority and positively impact the quality of care. PMID:27497022

  7. Coordinating Care for Children with Special Health Care Needs

    OpenAIRE

    Stephanie Peterson; Shanna Shulman; Henry Ireys

    2007-01-01

    This brief, the fourth in a series on critical issues involved in caring for children with special health care needs, notes that nearly three-quarters of parents who need professional care coordination services for their child say they do not get enough help—if they get any at all. Moreover, one-third of those who do get help are not fully satisfied with the quality of services they receive. Although many health plans coordinate care for their adult members with chronic conditions and disab...

  8. Comprehensive Care

    Science.gov (United States)

    ... Providing emotional support Comprehensive care includes attention to emotional health as well as physical health. Mental health professionals provide support and education, as well as diagnose and treat the depression, ...

  9. Multidisciplinary Care.

    Science.gov (United States)

    Daly, Megan E; Riess, Jonathan W

    2016-01-01

    Optimal multidisciplinary care of the lung cancer patient at all stages should encompass integration of the key relevant medical specialties, including not only medical, surgical, and radiation oncology, but also pulmonology, interventional and diagnostic radiology, pathology, palliative care, and supportive services such as physical therapy, case management, smoking cessation, and nutrition. Multidisciplinary management starts at staging and tissue diagnosis with pathologic and molecular phenotyping, extends through selection of a treatment modality or modalities, management of treatment and cancer-related symptoms, and to survivorship and end-of-life care. Well-integrated multidisciplinary care may reduce treatment delays, improve cancer-specific outcomes, and enhance quality of life. We address key topics and areas of ongoing investigation in multidisciplinary decision making at each stage of the lung cancer treatment course for early-stage, locally advanced, and metastatic lung cancer patients. PMID:27535399

  10. Gluten Sensitivity.

    Science.gov (United States)

    Catassi, Carlo

    2015-01-01

    Non-celiac gluten sensitivity (NCGS) is a syndrome characterized by intestinal and extraintestinal symptoms related to the ingestion of gluten-containing food in subjects who are not affected by either celiac disease (CD) or wheat allergy (WA). The prevalence of NCGS is not clearly defined yet. Indirect evidence suggests that NCGS is slightly more common than CD, the latter affecting around 1% of the general population. NCGS has been mostly described in adults, particularly in females in the age group of 30-50 years; however, pediatric case series have also been reported. Since NCGS may be transient, gluten tolerance needs to be reassessed over time in patients with NCGS. NCGS is characterized by symptoms that usually occur soon after gluten ingestion, disappear with gluten withdrawal, and relapse following gluten challenge within hours/days. The 'classical' presentation of NCGS is a combination of irritable bowel syndrome-like symptoms, including abdominal pain, bloating, bowel habit abnormalities (either diarrhea or constipation), and systemic manifestations such as 'foggy mind', headache, fatigue, joint and muscle pain, leg or arm numbness, dermatitis (eczema or skin rash), depression, and anemia. In recent years, several studies explored the relationship between the ingestion of gluten-containing food and the appearance of neurological and psychiatric disorders/symptoms like ataxia, peripheral neuropathy, schizophrenia, autism, depression, anxiety, and hallucinations (so-called gluten psychosis). The diagnosis of NCGS should be considered in patients with persistent intestinal and/or extraintestinal complaints showing a normal result of the CD and WA serological markers on a gluten-containing diet, usually reporting worsening of symptoms after eating gluten-rich food. NCGS should not be an exclusion diagnosis only. Unfortunately, no biomarker is sensitive and specific enough for diagnostic purposes; therefore, the diagnosis of NCGS is currently based on

  11. Caring Encounters

    Science.gov (United States)

    Gunn, Alyson

    2012-01-01

    Children with autism may seem to not care about things or have the same range of emotions as those of us who see them and care for them. But they do have empathy and they can be taught how to communicate it, says the author, a teacher of children with autism. We simply need to listen to them, watch them, and be with them in their moment.

  12. Multiple Chronic Conditions Among Medicare Beneficiaries...

    Data.gov (United States)

    U.S. Department of Health & Human Services — Individuals with multiple chronic conditions (MCC) present many challenges to the health care system, such as effective coordination of care and cost containment....

  13. Wound Care in Primary Health Care

    OpenAIRE

    Nail Ersoz; Ismail Hakki Ozerhan; Fatih Zor

    2008-01-01

    Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000): 71-74

  14. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull. 2008; 7(1: 71-74

  15. Wound Care in Primary Health Care

    Directory of Open Access Journals (Sweden)

    Nail Ersoz

    2008-02-01

    Full Text Available Wound care starts with occuring of wound. Primary health care wound care important as to affect on quality of healing. It is given information about the types of wounds, brief wound physiopathology and presented the options of wound care to primary health care wound care proffessionals in this article. Wound care must be done in a systematic process by health care professionals. [TAF Prev Med Bull 2008; 7(1.000: 71-74

  16. Context Sensitive Health Informatics

    DEFF Research Database (Denmark)

    Healthcare information technologies are now routinely deployed in a variety of healthcare contexts. These contexts differ widely, but the smooth integration of IT systems is crucial, so the design, implementation, and evaluation of safe, effective, efficient and easy to adopt health informatics...... involves careful consideration of both human and organizational factors. This book presents the proceedings of the Context Sensitive Health Informatics (CSHI) conference, held in Copenhagen, Denmark, in August 2013. The theme of this year’s conference is human and sociotechnical approaches. The Human......: patients and IT; usability test and evaluation; work tasks and related contexts; human factors and simulation; and context and systems design, and outline theories and models for studying contextual issues and insights related to how health information technologies can be better designed to accommodate...

  17. Comorbidity and the Use of Primary Care and Specialist Care in the Elderly

    OpenAIRE

    Starfield, Barbara; Lemke, Klaus W.; Herbert, Robert; Pavlovich, Wendy D.; Anderson, Gerard

    2005-01-01

    PURPOSE The impact of comorbidity on use of primary care and specialty services is poorly understood. The purpose of this study was to determine the relationship between morbidity burden, comorbid conditions, and use of primary care and specialist services

  18. Neurocritical care update.

    Science.gov (United States)

    Kuroda, Yasuhiro

    2016-01-01

    This update comprises six important topics under neurocritical care that require reevaluation. For post-cardiac arrest brain injury, the evaluation of the injury and its corresponding therapy, including temperature modulation, is required. Analgosedation for target temperature management is an essential strategy to prevent shivering and minimizes endogenous stress induced by catecholamine surges. For severe traumatic brain injury, the diverse effects of therapeutic hypothermia depend on the complicated pathophysiology of the condition. Continuous electroencephalogram monitoring is an essential tool for detecting nonconvulsive status epilepticus in the intensive care unit (ICU). Neurocritical care, including advanced hemodynamic monitoring, is a fundamental approach for delayed cerebral ischemia following subarachnoid hemorrhage. We must be mindful of the high percentage of ICU patients who may develop sepsis-associated brain dysfunction. PMID:27239312

  19. Final Report, The Teaching Parents Study: Pan-Britain, mixed methods study of multidisciplinary teams teaching parents, and parents learning to manage, home based care of long-term childhood kidney conditions

    OpenAIRE

    Veronica Swallow, Ruth Nightingale, Davina Allen, Julian Williams, Trish Smith, Jean Crosier, Heather Lambert, Leila Qizalbash, Lucy Wirz, Nicholas JA Webb, Cat Mercer, Laura Crowther.

    2012-01-01

    Background: Care of children and young people (children) in the 12 children’s kidney units in England, Scotland and Wales is managed by multidisciplinary teams (MDTs) comprising professionals such as clinical psychologists, dieticians, doctors, nurses, pharmacists, play workers, social workers, and therapists. Within the constraints of treatment regimens it is in children’s best interests for them to be cared for at home whenever possible1-4. Professionals therefore, spend considerable time ...

  20. Mental Health Collaborative Care and its Role in Primary Care Settings

    OpenAIRE

    Goodrich, David E.; Kilbourne, Amy M.; Nord, Kristina M; Bauer, Mark S

    2013-01-01

    Collaborative care models (CCMs) provide a pragmatic strategy to deliver integrated mental health and medical care for persons with mental health conditions served in primary care settings. CCMs are team-based intervention to enact system-level redesign by improving patient care through organizational leadership support, provider decision support, and clinical information systems as well as engaging patients in their care through self-management support and linkages to community resources. Th...

  1. Prediction of Unmet Primary Care Needs for the Medically Vulnerable Post-Disaster: An Interrupted Time-Series Analysis of Health System Responses

    Directory of Open Access Journals (Sweden)

    Amy B. Martin

    2012-09-01

    Full Text Available Disasters serve as shocks and precipitate unanticipated disturbances to the health care system. Public health surveillance is generally focused on monitoring latent health and environmental exposure effects, rather than health system performance in response to these local shocks. The following intervention study sought to determine the long-term effects of the 2005 chlorine spill in Graniteville, South Carolina on primary care access for vulnerable populations. We used an interrupted time-series approach to model monthly visits for Ambulatory Care Sensitive Conditions, an indicator of unmet primary care need, to quantify the impact of the disaster on unmet primary care need in Medicaid beneficiaries. The results showed Medicaid beneficiaries in the directly impacted service area experienced improved access to primary care in the 24 months post-disaster. We provide evidence that a health system serving the medically underserved can prove resilient and display improved adaptive capacity under adverse circumstances (i.e., technological disasters to ensure access to primary care for vulnerable sub-groups. The results suggests a new application for ambulatory care sensitive conditions as a population-based metric to advance anecdotal evidence of secondary surge and evaluate pre- and post-health system surge capacity following a disaster.

  2. Mechanisms of multiple chemical sensitivity.

    Science.gov (United States)

    Winder, Chris

    2002-03-10

    Sensitivity to chemicals is a toxicological concept, contained in the dose-response relationship. Sensitivity also includes the concept of hypersensitivity, although controversy surrounds the nature of effects from very low exposures. The term multiple chemical sensitivity has been used to describe individuals with a debilitating, multi-organ sensitivity following chemical exposures. Many aspects of this condition extend the nature of sensitivity to low levels of exposure to chemicals, and is a designation with medical, immunological, neuropsychological and toxicological perspectives. The basis of MCS is still to be identified, although a large number of hypersensitivity, immunological, psychological, neurological and toxicological mechanisms have been suggested, including: allergy; autosuggestion; cacosomia; conditioned response; immunological; impairment of biochemical pathways involved in energy production; impairment of neurochemical pathways; illness belief system; limbic kindling; olfactory threshold sensitivity; panic disorder; psychosomatic condition; malingering; neurogenic inflammation; overload of biotransformation pathways (also linked with free radical production); psychological or psychiatric illness; airway reactivity; sensitisation of the neurological system; time dependent sensitisation, toxicant induced loss of tolerance. Most of these theories tend to break down into concepts involving: (1) disruption in immunological/allergy processes; (2) alteration in nervous system function; (3) changes in biochemical or biotransformation capacity; (4) changes in psychological/neurobehavioural function. Research into the possible mechanisms of MCS is far from complete. However, a number of promising avenues of investigation indicate that the possibility of alteration of the sensitivity of nervous system cells (neurogenic inflammation, limbic kindling, cacosomia, neurogenic switching) are a possible mechanism for MCS. PMID:11869820

  3. Wound Care.

    Science.gov (United States)

    Balsa, Ingrid M; Culp, William T N

    2015-09-01

    Wound care requires an understanding of normal wound healing, causes of delays of wound healing, and the management of wounds. Every wound must be treated as an individual with regard to cause, chronicity, location, and level of microbial contamination, as well as patient factors that affect wound healing. Knowledge of wound care products available and when negative pressure wound therapy and drain placement is appropriate can improve outcomes with wound healing. Inappropriate product use can cause delays in healing. As a wound healing progresses, management of a wound and the bandage material used must evolve. PMID:26022525

  4. Analysis of Candida infections and drug sensitivity in intensive care unit%重症监护病房念珠菌感染情况及药敏分析

    Institute of Scientific and Technical Information of China (English)

    贾磊; 郁慧杰; 陆锦琪; 马燮峰; 刘宇婷; 张玉琦; 蔡莹

    2014-01-01

    Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4

  5. Analysis of Candida infections and drug sensitivity in intensive care unit%重症监护病房念珠菌感染情况及药敏分析

    Institute of Scientific and Technical Information of China (English)

    贾磊; 郁慧杰; 陆锦琪; 马燮峰; 刘宇婷; 张玉琦; 蔡莹

    2014-01-01

    Objective To study the distribution of Candida infection and drug tolerance in intensive care unit(ICU). Methods A retrospective study was conducted. The critical patients admitted from January 2011 to December 2013 in ICU of the First Hospital of Jiaxing in Zhejiang Province were enrolled,and their clinical data with positive Candida culture and drug susceptibility results in specimens of sputum,urine,blood,ascites,bile, etc were collected. In the study of these 3 years in ICU,the situation of Candida infection,the distribution of positive specimen,the condition of distribution of different strains of Candida,and the Candida tolerance to antifungal drugs were analyzed. Results From 2011 to 2013,2 412 times of patients(including one patient had admitted into ICU for more than one time)were admitted into ICU in which 407 cases were of Candida infection(16.9%),and the rate of Candida infection was rising gradually in the 3 years〔2011 to 2013 Candida positive rates were 13.4%(77/573), 16.1%(146/907),19.7%(184/932)〕,the difference being statistically significant(P<0.01). In the 407 strains of Candida,166 strains(40.8%)were isolated from sputum,157(38.6%)from urine,53 strains(13.0%)ascites, 13 strains(3.1%)blood,11 strains(2.7%)bile,7 strains(1.7%)from other specimens. The strain distribution of Candida was mainly as follows:Candida albicans(174 strains),Candida glabrata(131 strains),Candida tropicalis (83 strains),Candida parapailosis(5 strains),Candida krusei(12 strains),and 2 strains of rare Candida portugal and Lipolztica. From 2011 to 2013,the highest tolerance of Candida albicans,Candida glabrata,Candida tropicalis to fluconazole,itraconazole,Fushita Yasu and other antifungal drugs was in 2013,and the lowest was in 2012,the rates of tolerance of the above 3 strains of Candida to amphotericin B being 0,to itraconazole being the highest(10.9%, 27.8%,9.6%,respectively),to Fushita Yasu the secondary(6.6%,11.0%,0,respectively)and to fluconazole the last(4

  6. Pulmonary Edema Assessed by Ultrasound: Impact in Cardiology and Intensive Care Practice.

    Science.gov (United States)

    Blanco, Pablo A; Cianciulli, Tomás F

    2016-05-01

    Pulmonary edema is a frequent condition found in adult patients hospitalized in cardiology wards and intensive care units. Ultrasonography is a diagnostic modality with a high sensitivity for the detection of extravascular lung water, visualized as B lines, and usually caused by cardiogenic or noncardiogenic pulmonary edema. This paper highlights a simple method for the assessment of patients with pulmonary edema, which allows for a differential diagnosis of its possible mechanism and contributes to therapeutic intervention guiding and monitoring. PMID:26841270

  7. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal1

    Science.gov (United States)

    de Figueiredo, Paula Alvarenga; Alvim, Neide Aparecida Titonelli

    2016-01-01

    Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing. PMID:27192418

  8. Guidelines for a Comprehensive Care Program to Ostomized Patients and Families: a Nursing proposal

    Directory of Open Access Journals (Sweden)

    Paula Alvarenga de Figueiredo

    2016-01-01

    Full Text Available Objectives: describe care needs and demands that mark the discursive practices of ostomized clients and family members and discuss guidelines for a comprehensive care program to ostomized clients and their families, organized by macrosociological categories. Method: Creative and Sensitive, involving 17 ostomized subjects and family members at a municipal outpatient clinic. The ethical aspects were complied with. A characterization form was used, as well as Creativity and Sensitivity Dynamics: "speaking map", "body-knowledge" and "calendar". Critical Discourse Analysis was applied. Results: the health needs and care demands of the ostomized patients and their family members, in their multiple dimensions, were constituted in the home and community, outpatient and social context, implying new orientations for nursing care. The unveiling of the data brought elements that constituted guidelines, in a macrosociological approach, to achieve the expanded integrality of nursing care. Conclusion: the ostomized clients are unique in their genre/peculiar from Latin sui generis, calling for strategies that respond to and distinguish their specificities. Elaborating a Public Health Policy that improves and reorganizes the care demands, taking into account these individual biopsychosocial and spiritual aspects, is a possible and irrevocable target in the attempt to achieve better conditions of health and wellbeing.

  9. [Palliative care in neurology].

    Science.gov (United States)

    Provinciali, Leandro; Tarquini, Daniela; De Falco, Fabrizio A; Carlini, Giulia; Zappia, Mario; Toni, Danilo

    2015-07-01

    Palliative care in neurology is characterized by the need of taking into account some distinguishing features which supplement and often differ from the general palliative approach to cancer or to severe organ failures. Such position is emphasized by a new concept of palliative assistance which is not limited to the "end of life" stage, as it was the traditional one, but is applied along the entire course of progressive, life-limiting, and disabling conditions. There are various reasons accounting for a differentiation of palliative care in neurology and for the development of specific expertise; the long duration of the advanced stages of many neurological diseases and the distinguishing features of some clinical problems (cognitive disorders, psychic disorders, etc.), in addition to the deterioration of some general aspects (nutrition, etc.), make the general criteria adopted for cancer, severe respiratory, hepatic or renal failures and heart failure inadequate. The neurological diseases which could benefit from the development of a specific palliative approach are dementia, cerebrovascular diseases, movement disorders, neuromuscular diseases, severe traumatic brain injury, brain cancers and multiple sclerosis, as well as less frequent conditions. The growing literature on palliative care in neurology provides evidence of the neurological community's increasing interest in taking care of the advanced and terminal stages of nervous system diseases, thus encouraging research, training and updating in such direction. This document aims to underline the specific neurological requirements concerning the palliative assistance. PMID:26228722

  10. How to communicate: ''I care''

    International Nuclear Information System (INIS)

    In the competitive health care environment, organizations are concerned with patients' perceptions of health care received. The nurse in the radiology setting has the unique opportunity to be involved with all patient populations. In the area of verbal-nonverbal communication, the nurse often responds automatically without always being sensitive to how the response is perceived by the other person. This session is a review of the health care provider's need for basic sensitivity to others and an ability to respond effectively to emotional issues. The objectives of this session are to enable readers to (1) identify appropriate methods of approaching a person in a wheelchair, (2) state basic fundamental ideas when communicating and working with a confused or head-injured person, and (3) identify appropriate words to project positive mental images for people who happen to have a disability

  11. Home Care

    Science.gov (United States)

    ... care is especially useful for persons who need nursing, therapy, or aide services. You may need help if you are dealing with one or more of the following: You have trouble getting around (for example, after a hospital stay or an accident) You have wounds that need to be cleaned, ...

  12. Enacting Care

    Czech Academy of Sciences Publication Activity Database

    Urban, Petr

    2015-01-01

    Roč. 9, č. 2 (2015), s. 216-222. ISSN 1749-6535 R&D Projects: GA ČR(CZ) GPP401/12/P544 Institutional support: RVO:67985955 Keywords : ethics of care * enactivism * autonomy * social institutions * autism * exclusion Subject RIV: AA - Philosophy ; Religion http://dx.doi.org/10.1080/17496535.2015.1022356

  13. Who cares?

    DEFF Research Database (Denmark)

    Petersen, Morten Krogh

    practices. If that is the case, the great challenge is to “come up with ingenious solutions to the problem of how to become interesting enough for practices to care about” (ibid: 72). Through ethnographic fieldwork encounters with Radicand Design Collaboratory, a collaborative product development...

  14. [DIE TAKING CARE].

    Science.gov (United States)

    Re, Cecilia

    2016-02-01

    Under the paradigm of complex thought, Edgar Morin and the pedagogy of the oppressed by Paulo Freire we describe and explain briefly the reasons of the squalid conditions in which develops the work of caring, which is not only an art and a science. The review of scientific literature, as well as the stories of life, support the need for a pedagogical reference change in vocational training programs. PMID:27101646

  15. Generalized tolerance sensitivity and DEA metric sensitivity

    OpenAIRE

    Luka Neralić; Richard E. Wendell

    2015-01-01

    This paper considers the relationship between Tolerance sensitivity analysis in optimization and metric sensitivity analysis in Data Envelopment Analysis (DEA). Herein, we extend the results on the generalized Tolerance framework proposed by Wendell and Chen and show how this framework includes DEA metric sensitivity as a special case. Further, we note how recent results in Tolerance sensitivity suggest some possible extensions of the results in DEA metric sensitivity.

  16. Frequency of candidemias in a tertiary care intensive care unit

    International Nuclear Information System (INIS)

    Objective: To determine the frequency of fungal infections in intensive care unit (ICU) of Military Hospital, Rawalpindi, a tertiary care health facility. Study Design: Cross sectional study. Place and Duration of Study: Intensive Care Department of Military Hospital Rawalpindi from 01 Jan 2012 to 30 Jun 2012. Methodology: A total of 89 patients were screened with stay of more than 5 days in intensive care unit. Thirty cases were enrolled in the study for investigation of fungal infections that had fever even after 05 days of being on broad spectrum antibiotics. Culture was done on blood, urine and catheter tip samples as per clinical condition of a patient. Results: Candida infection was found in 23.4% of study cases. The mean age of study patients was 41.2 +- 20.0 years while 63.4% were female patients as compared to 36.7% males. Conclusion: Fungal infections especially candidemias are quite frequent in the intensive care units. (author)

  17. Hydrogen embrittlement of sensitized inconel 600

    International Nuclear Information System (INIS)

    Tensile tests under cathodic charging were carried out on sensitized Inconel 600 alloy poly crystals. The maximum sensitivity of hydrogen embrittlement (HE) was recognized on the specimen sensitized at 973K, and the specimen fractured with intercrystalline mode. The effect of cold working before the sensitized treatment was recognized in the sensitivity of HE and the morphology of fractured surface. When the prestrain increased, the sensitivity of HE was decreased and the fracture morphology changed from intercrystalline to transgranular. On the single crystal specimen, no effect was recognized in both the sensitized temperature and the cold working before sensitization. Intercrystalline and transcrystalline cracks occurred on the surface of polycrystal specimen by hydrogen charging under no loading condition. Also, the cracks on the surface of single crystal specimen were produced along {001} planes hydrogen under the same condition. (author)

  18. Reliability of medical audit in quality assessment of medical care

    Directory of Open Access Journals (Sweden)

    Camacho Luiz Antonio Bastos

    1996-01-01

    Full Text Available Medical audit of hospital records has been a major component of quality of care assessment, although physician judgment is known to have low reliability. We estimated interrater agreement of quality assessment in a sample of patients with cardiac conditions admitted to an American teaching hospital. Physician-reviewers used structured review methods designed to improve quality assessment based on judgment. Chance-corrected agreement for the items considered more relevant to process and outcome of care ranged from low to moderate (0.2 to 0.6, depending on the review item and the principal diagnoses and procedures the patients underwent. Results from several studies seem to converge on this point. Comparisons among different settings should be made with caution, given the sensitivity of agreement measurements to prevalence rates. Reliability of review methods in their current stage could be improved by combining the assessment of two or more reviewers, and by emphasizing outcome-oriented events.

  19. Maternal care

    OpenAIRE

    2001-01-01

    In June 2000 a distinguished group of obstetricians, midwives, general practitioners, and medical statisticians came together to discuss maternal care. Chaired by Professor James Drife from Leeds, discussion ranged over many topics, including: the changing role of the obstetrician, general practitioners, and the increasing status and responsibility of midwives. Other subjects include the induction of labour, obstetric analgesia and anaesthesia, and debates about the place and kind of delivery...

  20. The Sensitive Skin Syndrome

    Directory of Open Access Journals (Sweden)

    Hadar Lev-Tov

    2012-01-01

    Full Text Available Sensitive skin syndrome (SSS is a common and challenging condition, yet little is known about its underlying pathophysiology. Patients with SSS often present with subjective complaints of severe facial irritation, burning, and/or stinging after application of cosmetic products. These complaints are out of proportion to the objective clinical findings. Defined as a self-diagnosed condition lacking any specific objective findings, SSS is by definition difficult to quantify and, therefore, the scientific community has yet to identify an acceptable objective screening test. In this overview we review recent epidemiological studies, present current thinking on the pathophysiology leading to SSS, discuss the challenges SSS presents, and recommend a commonsense approach to management.

  1. [Take care of a child, one work like any other?].

    Science.gov (United States)

    Bloch, Françoise

    2010-01-01

    This article has its roots in the basic contradictions, which go back to the eighteenth and nineteenth centuries, between the self-interest and the care of others, exemplified by the delegation of responsibility for the care of children and other vulnerable persons. This splitting of human life-supporting activities has sealed women's dependence on men by setting off the lucrative area from the private, non-lucrative sphere of activities. These contradictions become paradoxical as soon as we consider the delegation of responsibility for the care of a child to someone not related to the child. This article addresses the question of how the child's developmental needs can be met without damage to his/her sensitivity, and his/her perception of others or of the cooperation involved. As soon as it is born, the child, a thoroughly interactive being, discerns the relationships it entertains with those who are in charge of him/her. The persons - mostly women - who take care of the child are not interchangeable, since they bring their own subjectivity into their dealings with the child and this is reciprocal. The women's skills, frequently thought to be “undefinable”, but which many women, whether related or not to the child, have developed or should develop, are brought into play and are either transmitted or acquired in the course of their care of the child; these skills are not by nature “feminine skills”, but they require a great deal of reactivity and sensitivity and therefore, many child professionals, mothers' aids and children's care-takers in the home are hurt and insulted by the low esteem in which they are held. These skills and human qualities, which are the result of feelings more than of formalised knowledge, techniques or theories - albeit these are also necessary - make child care and child rearing an art. These skills seem to be in total contradiction with those that are current in the world of labour, where the tempo of work, flexibility of working

  2. Developing a web 2.0 diabetes care support system with evaluation from care provider perspectives.

    Science.gov (United States)

    Lin, Yung-Hsiu; Chen, Rong-Rong; Guo, Sophie Huey-Ming; Chang, Hui-Yu; Chang, Her-Kun

    2012-08-01

    Diabetes is a life-long illness condition that many diabetic patients end up with related complications resulted largely from lacking of proper supports. The success of diabetes care relies mainly on patient's daily self-care activities and care providers' continuous support. However, the self-care activities are socially bounded with patient's everyday schedules that can easily be forgotten or neglected and the care support from providers has yet been fully implemented. This study develops a Web 2.0 diabetes care support system for patients to integrate required self-care activities with different context in order to enhance patient's care knowledge and behavior adherence. The system also supports care managers in a health service center to conduct patient management through collecting patient's daily physiological information, sharing care information, and maintaining patient-provider relationships. After the development, we evaluate the acceptance of the system through a group of nursing staffs. PMID:21369781

  3. The challenge of supporting care for dementia in primary care

    Directory of Open Access Journals (Sweden)

    Malaz Boustani

    2007-01-01

    Full Text Available Malaz Boustani1,2,3, Cathy Schubert3, Youcef Sennour31Indiana University Center for Aging Research; 2Regenstrief Institute; 3Department of Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USAAbstract: Most patients with dementia receive care within primary care systems and have challenging medical and psychiatric issues. Their dementia related symptoms are often not recognized by the primary care system; they suffer from multiple chronic medical conditions; receive numerous psychotropic medications including anticholinergics; and display clinically relevant behavioral and psychological symptoms. Improving the care for such vulnerable patients demands supporting the primary care system with various resources, including dementia care managers, access to and coordination with interdisciplinary dementia specialists, and a feasible dementia screening and diagnosis process. Understanding primary care clinics as a complex adaptive system may enhance our capacity to deliver a flexible supportive process using the above crucial resources to adequately assess and effectively manage patients with dementia. Such a complex adaptive system process would have the best probability of surviving the unknowable future challenges that will face the primary care system.

  4. Workshop: integration of care at the interface of primary and secondary care: work in progress.

    NARCIS (Netherlands)

    Zee, J. van der

    2010-01-01

    Background and aim: Existing health care arrangements do not always provide a well-organized response to health problems occurring in society. Inadequate coordination of care for people with chronic conditions or elderly in need for home care services provide examples of important integration issues

  5. Defining and measuring integrated patient care: promoting the next frontier in health care delivery.

    NARCIS (Netherlands)

    Singer, S.J.; Burgers, J.S.; Friedberg, M.; Rosenthal, M.B.; Leape, L.; Schneider, E.

    2011-01-01

    Integration of care is emerging as a central challenge of health care delivery, particularly for patients with multiple, complex chronic conditions. The authors argue that the concept of "integrated patient care" would benefit from further clarification regarding (a) the object of integration and (b

  6. Designing self-care for everyday life

    DEFF Research Database (Denmark)

    Verdezoto, Nervo; Nunes, Francisco; Grönvall, Erik; Fitzpatrick, Geraldine; Storni, Cristiano; Kyng, Morten

    Managing chronic conditions can be challenging. People in such conditions, and the people around them, have to: deal with symptoms, adapt to the resulting disability, manage emotions, and change habits to keep the condition under control. Self-care technologies have the potential to support self......-care and mediate the relationship between patients (and caregivers) and the condition. However, these technologies often disregard the complexity of the settings in which they are used and fail to become integrated in everyday life. In this workshop we will discuss how to design self-care technologies that...

  7. Probabilistic sensitivity analysis of biochemical reaction systems

    OpenAIRE

    Zhang, Hong-Xuan; Dempsey, William P.; Goutsias, John

    2009-01-01

    Sensitivity analysis is an indispensable tool for studying the robustness and fragility properties of biochemical reaction systems as well as for designing optimal approaches for selective perturbation and intervention. Deterministic sensitivity analysis techniques, using derivatives of the system response, have been extensively used in the literature. However, these techniques suffer from several drawbacks, which must be carefully considered before using them in problems of systems biology. ...

  8. [Interactions of partners in family pairs, care of the offspring, and the role of tactile stimulation in formation of parental behavior of the Mongolian gerbil (Meriones unguiculatus) under laboratory conditions].

    Science.gov (United States)

    Gromov, V S

    2009-01-01

    The interactions of sexual partners and care of the offspring in male and female Mongolian gerbils reared in biparental and uniparental family groups (without an adult male) were compared. In individuals reared in biparental family groups, sexual differences related to the manifestation of parental care were small and statistically insignificant. In individuals reared in uniparental groups, the interactions of sexual partners related to grooming changed; the duration in males decreased threefold, as compared to the norm; indices of parental behavior of females and, especially of males, related to tactile stimulation of pups (huddling with pups in the nest and duration of licking pups) also decreased. The importance of the parental contribution of males, especially of tactile stimulation, in the evolution of the family-group mode of life is discussed. PMID:19899220

  9. Standardized care plan of postpartum mastitis

    Directory of Open Access Journals (Sweden)

    Maria Ángeles Carrasco García

    2012-07-01

    Full Text Available Introduction: Puerperal mastitis or mastitis Breastfeeding is a postpartum condition that represents one of the main reasons for abandoning breastfeeding. Mainly usually occurs between weeks 2 and 3 ª postpartum. The scientific evidence confirms that the stop breastfeeding before an attack of mastitis is not conducive to recovery and that of exclusive breastfeeding and no restrictions are effective measures to prevent milk stasis and the spread of infection.Objective: The main objective is to unify criteria for the care and integrated health care levels of care through continuity of care to promote breast-specific care to prevent the emergence of this disease.Methodology: Development of a standardized care plan to enable effective communication between professionals and implementation of quality care.Conclusions: The midwife and the nurse plays an important role in identifying those women with early-onset symptoms of postpartum mastitis in the middle, both in the maternity ward and in the primary care clinic.

  10. Diagnostics in critical conditions

    OpenAIRE

    SadchikovD.V.; PrigorodovM.V.; IvanovR.V.

    2011-01-01

    The purpose of research: improvement of quality of diagnostics at the patients in a critical condition in intensive care unit. Material and methods. In total have analyzed 1957 medical cards of the patients who have died in ICU»s. At the first stage studied the factors influencing on diagnostics of critically ill patients (medical cards of 1557 patients); at the second stage investigated influence of the diagnostic standards in ICU»s practice on improvement of quality of diag- nostics of crit...

  11. The Relevance of the Affordable Care Act for Improving Mental Health Care.

    Science.gov (United States)

    Mechanic, David; Olfson, Mark

    2016-03-28

    Provisions of the Affordable Care Act provide unprecedented opportunities for expanded access to behavioral health care and for redesigning the provision of services. Key to these reforms is establishing mental and substance abuse care as essential coverage, extending Medicaid eligibility and insurance parity, and protecting insurance coverage for persons with preexisting conditions and disabilities. Many provisions, including Accountable Care Organizations, health homes, and other structures, provide incentives for integrating primary care and behavioral health services and coordinating the range of services often required by persons with severe and persistent mental health conditions. Careful research and experience are required to establish the services most appropriate for primary care and effective linkage to specialty mental health services. Research providing guidance on present evidence and uncertainties is reviewed. Success in redesign will follow progress building on collaborative care and other evidence-based practices, reshaping professional incentives and practices, and reinvigorating the behavioral health workforce. PMID:26666969

  12. Who cares!

    Institute of Scientific and Technical Information of China (English)

    老晃

    2013-01-01

    1有人再三怂恿,希望我能吐槽《富春山居图》,务求鞭辟入里,揭露丑恶真相。我舍不得,舍不得浪费纸。好吧,小吐一下。传说,在《富春山居图》开拍之前有心人提醒导演孙健君,剧本有硬伤,得改,例举一三三四……话没说完,孙勃然大怒,"Who cares!"这位目空一切的君王,他什么都不care,所以他花钱砸的那堆玩意儿,根本也不是电影。这就是真相。值得一说的,是此刻红得发紫,摸都摸不得的《小时代》。

  13. Princeton HealthCare System name reflects comprehensive services. New brand identity focuses on 'Redefining Care'.

    Science.gov (United States)

    Botvin, Judith D

    2004-01-01

    The Medical Center at Princeton, Princeton, N.J., introduced its new name last June, both to its community and its internal stakeholders. It is now known as Princeton HealthCare System, a name chosen to reflect its growth and diversity. It's being branded as a unique institution that combines the sensitive, caring serice of a community hospital with the sophisticated care of a teaching hospital. PMID:15162577

  14. Regional climatology sensitivity studies

    International Nuclear Information System (INIS)

    Regional interest in understanding climate and climate change at regional scales has led to the application of mesoscale models for regional climatology studies. These models can provide an understanding of climate processes in a physically consistent way at much higher resolution than currently offered by general circulation models (GCMs). This paper presents results from two simple regional climate sensitivity experiments designed to test the impact of grid configuration on the prediction of precipitation. The simulated precipitation was first compared with observed data interpolated to model grid points. Assessing the accuracy of the modeling results is complicated by the fact that the mesoscale precipitation data set used for model validation is too sparse to provide a rigorous evaluation of the model's performance. The modeling results show that grid configuration must be given very careful consideration before a regional model can be implemented for climate studies over a particular area of interest. Results presented here suggest that seemingly minor changes in domain boundaries and grid resolution can have a dramatic impact upon predicted results

  15. Health Care of the Elderly in Medically Disadvantaged Populations.

    Science.gov (United States)

    German, Pearl S.; And Others

    1978-01-01

    This study of three disadvantaged urban areas reports on the relationship between available resources and ambulatory health care. Findings indicate a high proportion of elderly receiving care for serious conditions but a sharp drop in care for less serious but potentially disabling conditions. (Author)

  16. Knowledge sharing behaviour and intensive care nurse innovation: the moderating role of control of care quality

    DEFF Research Database (Denmark)

    Li-Ying, Jason; Paunova, Minna; Egerod, Ingrid

    2016-01-01

    of the questionnaire were used – one designed for nurse employees and the other for the managing nurse(s). An ordinary least squares regression analysis was used to test the hypotheses. Results Different aspects of knowledge sharing affect innovation differently, depending on the strength of the control of care......Aims This study investigates the influence of intensive care unit nurses’ knowledge sharing behaviour on nurse innovation, given different conditions of care quality control. Background Health-care organisations face an increasing pressure to innovate while controlling care quality. We have little...... insight on how the control of care quality interacts with the knowledge sharing behaviour of intensive care nurses to affect their innovative behaviours. Methods We developed a multi-source survey study of more than 200 intensive care nurses at 22 intensive care units of 17 Danish hospitals. Two versions...

  17. A multilevel study on the association of observer-assessed working conditions with depressive symptoms among female eldercare workers from 56 work units in 10 care homes in Denmark

    DEFF Research Database (Denmark)

    Jakobsen, Louise M.; Jorgensen, Anette F. B.; Thomsen, Birthe L.;

    2015-01-01

    -observed individuals. We used regression models that allowed for correlations within work units and care homes and adjusted these models for demographics, job characteristics and stressful life events. RESULTS: Higher levels of regulation requirements were associated with lower depressive symptoms at the individual...... of depressive symptoms in the age and cohabitation adjusted model, however statistical significance was lost in the fully adjusted model. CONCLUSIONS: Low level of regulation requirements was associated with a high level of depressive symptoms. The study highlights the importance of examining both...

  18. [Promoting citizenship through nursing care].

    Science.gov (United States)

    Backes, Dirce Stein; Backes, Marli Stein; Erdmann, Alacoque Lorenzini

    2009-01-01

    This study is the result of the project: networks care and social entrepreneurship: the autonomy and social commitment of nurses. The purpose of this qualitative study is to comprehend the meaning of nursing care as a social enterprising practice. The Grounded Theory was used as a methodological reference and the interview, conducted with 35 participants as technique of data collection. Data codification led to the central theme: Viewing Nursing Care as a Social Enterprising Practice. This theme is complemented by the category, characterized the cause condition: the social integration through the creation a political identity that expresses your involvement. The results showed that is necessary to learn and have a deep dialogic knowledge. In order to consolidate popular participation as a citizenship ideal, a critical professional attitude, base don the combination of care with liberty, participation end autonomy. PMID:19597667

  19. Self-care practice of patients with arterial hypertension in primary health care

    Directory of Open Access Journals (Sweden)

    Cláudia Rayanna Silva Mendes

    2016-02-01

    Full Text Available Objective: to evaluate the practice of self-care performed by patients with systemic arterial hypertension in primary health care. Methods: this is a descriptive and cross-sectional study, conducted with 92 individuals with arterial hypertension in a primary care unit. The data collection occurred through script and data analyzed using descriptive statistics (frequency, mean and standard deviation and through the understanding of the adaption between capacity and self-care demand. Results: it was identified as a practice of self-care: adequate water intake, salt intake and restricted coffee, satisfactory sleep period, abstinence from smoking and alcoholism, continuing pharmacological treatment and attending medical appointments. As the demands: inadequate feeding, sedentary lifestyle, had no leisure activities, self-reported stress, and limited knowledge. Conclusion: although patients performed treatment a few years ago, still showed up self-care deficits, highlighting the need for nurses to advise and sensitize about the importance of self-care practice.

  20. [Antenatal care in immigrants].

    Science.gov (United States)

    de la Torre, J; Coll, C; Coloma, M; Martín, J I; Padrón, E; González González, N L

    2006-01-01

    The phenomenon of immigration has had an impact on the health care of the population. The immigrant population in Spain today represents approximately 8% of the total population. The majority of this population proceeds from countries with low income, and its origin and distribution is diverse. The immigrant population is characterised by its being young and healthy, and with a capacity to adapt to changes, but its social, economic and labour conditions are frequently insecure and favour vulnerability to disease. In spite of the number of immigrants of the male sex being globally higher than that of women, the percentage of immigrants of the female sex is growing. This increase of the female immigrant population has resulted in the appearance of specific health care needs, especially with respect to sexual and reproductive health. To which we must add a substantial increase in pathologies prevalent in the countries of origin, such as anaemia, tuberculosis, malnutrition, haemoglobinopathies, consanguinity, hypocalcaemia, hepatitis B and/or C, sexually transmitted infections, infectious diseases transmitted by arthropods, such as Chagas disease and other parasitoses, as well as genital mutilations. The aim of this article is to analyse the factors that make it difficult to control gestation in the immigrant population, as well as to establish guidelines for acting in antenatal care consultations. Insistence is placed on health education and prevention during pregnancy, and consideration is given to the appearance of rare diseases related to some of these groups. PMID:16721417